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Developing a safe and effective preventive for HIV-1 remains the hope for controlling the global AIDS epidemic. Recently, mRNA vaccines have emerged as a promising alternative to conventional vaccine approaches, primarily due to their rapid development and potential for low-cost manufacture. Despite the advantages of mRNA vaccines, challenges remain, especially due to the adverse effects of the delivery vehicle and low delivery efficiency. As a result, Luna Labs is developing a short carbon nanotube-based delivery platform (NanoVac) that can co-deliver mRNA and HIV-1 glycoproteins to the immune system efficiently with negligible toxicity. Surface chemistries of NanoVac were optimized to guide antigen/mRNA loading density and presentation. Multiple formulations were engineered for compatibility with both intramuscular and intranasal administration. NanoVac candidates demonstrated immunogenicity in rabbits and generated human-derived humoral and cellular responses in humanized mice (HIS). Briefly, 33% of the HIV-1–infected HIS mice vaccinated with NanoVac–mRNA was cleared of virus infection by 8–weeks post-infection. Finally, NanoVac stabilized the loaded mRNA against degradation under refrigeration for at least three months, reducing the cold chain burden for vaccine deployment.

Background The Woven EndoBridge (WEB) device was explicitly designed for wide-neck intracranial bifurcation aneurysms. Small-scale reports have evaluated the off-label use of WEB devices for the treatment of sidewall aneurysms, with promising outcomes. Purpose To compare the angiographic and clinical outcomes of the WEB device for the treatment of sidewall aneurysms compared with the treatment of bifurcation aneurysms. Materials and Methods A retrospective review of the WorldWideWEB Consortium, a synthesis of retrospective databases spanning from January 2011 to June 2021 at 22 academic institutions in North America, South America, and Europe, was performed to identify patients with intracranial aneurysms treated with the WEB device. Characteristics and outcomes were compared between bifurcation and sidewall aneurysms. Propensity score matching (PSM) was used to match by age, pretreatment ordinal modified Rankin Scale score, ruptured aneurysms, location of aneurysm, multiple aneurysms, prior treatment, neck, height, dome width, daughter sac, and incorporated branch. Results A total of 683 intracranial aneurysms were treated using the WEB device in 671 patients (median age, 61 years [IQR, 53-68 years]; male-to-female ratio, 1:2.5). Of those, 572 were bifurcation aneurysms and 111 were sidewall aneurysms. PSM was performed, resulting in 91 bifurcation and sidewall aneurysms pairs. No significant difference was observed in occlusion status at last follow-up, deployment success, or complication rates between the two groups. Conclusion No significantly different outcomes were observed following the off-label use of the Woven EndoBridge, or WEB, device for treatment of sidewall aneurysms compared with bifurcation aneurysms. The correct characterization of the sidewall aneurysm location, neck angle, and size is crucial for successful treatment and lower retreatment rate. © RSNA, 2022 See also the editorial by Hetts in this issue.

Background and purpose Previous studies suggest that mechanisms and outcomes in patients with COVID-19-associated stroke differ from those in patients with non-COVID-19-associated strokes, but there is limited comparative evidence focusing on these populations. The aim of this study, therefore, was to determine if a significant association exists between COVID-19 status with revascularization and functional outcomes following thrombectomy for large vessel occlusion (LVO), after adjustment for potential confounding factors. Methods A cross-sectional, international multicenter retrospective study was conducted in consecutively admitted COVID-19 patients with concomitant acute LVO, compared to a control group without COVID-19. Data collected included age, gender, comorbidities, clinical characteristics, details of the involved vessels, procedural technique, and various outcomes. A multivariable-adjusted analysis was conducted. Results In this cohort of 697 patients with acute LVO, 302 had COVID-19 while 395 patients did not. There was a significant difference (p < 0.001) in the mean age (in years) and gender of patients, with younger patients and more males in the COVID-19 group. In terms of favorable revascularization (modified Thrombolysis in Cerebral Infarction [mTICI] grade 3), COVID-19 was associated with lower odds of complete revascularization (odds ratio 0.33, 95% confidence interval [CI] 0.23-0.48; p < 0.001), which persisted on multivariable modeling with adjustment for other predictors (adjusted odds ratio 0.30, 95% CI 0.12-0.77; p = 0.012). Moreover, endovascular complications, in-hospital mortality, and length of hospital stay were significantly higher among COVID-19 patients (p < 0.001). Conclusion COVID-19 was an independent predictor of incomplete revascularization and poor functional outcome in patients with stroke due to LVO. Furthermore, COVID-19 patients with LVO were more often younger and had higher morbidity/mortality rates.

Clamoring human progress is the vein through which present day development is worked. Every day, energy is used to its fullest potential to achieve the goals and desires of the entire population. Each side of our life is confined with different layers of obstacle and in this reaction; energy is turning into a key element. Therefore, in order to propel this enormous population forward, the energy source must be inexhaustible or everlasting. People being developmental in nature are maybe the best making of nature is consistently in the race of imagining the likely and accessible solaces and advantages in each conceivable point in this hazardous world. Our aphorism is to attempt in sending such honourable objective of energy protection. Taking a gander at the current situation it is obvious that regular wellsprings of energy like coal, petroleum gas, oil, and so on are on the verge of disappearing. The demand for these energy resources has reached its zenith due to the fact that they are fighting a losing battle with time itself to meet each and every demand for energy. The ordinary utilization of energies because of the consuming of petroleum derivatives like coal, oil and flammable gas, the entire climate is getting dirtied. As a result, the components of the current project, such as the LDR module, DC motor, photovoltaic array, and others, are coordinated. According to which, in contrast to other conventional energy uses, the functioning of would not produce any pollution and serve as a reservoir for the Sun's energy., {"references":["1.\tHsiao, Y. T., & Chen, C. H. (2002, October). Maximum power tracking for photovoltaic power system. In Conference record of the 2002 IEEE industry applications conference. 37th IAS Annual Meeting (Cat. No. 02CH37344) (Vol. 2, pp. 1035-1040). IEEE.","2.\tPillai, A. G. (2023). AUTOMATIC SOLAR TRACKING SYSTEM. Journal of Pharmaceutical Negative Results, 1849-1855.","3.\tHamilton, S. J. (1999). Sun-tracking solar cell array system. University of Queensland Department of Computer Science and Electrical Engineering, Bachelors Thesis.","4.\tFurkan, D., & Mehmet Emin, M. (2010). Critical factors that affecting efficiency of solar cells. smart grid and renewable energy, 2010.","5.\tWang, R., & Ge, T. (Eds.). (2016). Advances in solar heating and cooling. Woodhead Publishing.","6.\tBas, L. (2010). Thin Film vs. Crystalline Silicon PV Modules. CivicSolar, Inc.","7.\tPanait, M. A., & Tudorache, T. (2008, March). A simple neural network solar tracker for optimizing conversion efficiency in off-grid solar generators. In International Conference on Renewable Energies and Power Quality (pp. 256-260).","8.\tReca-Cardeña, J., & López-Luque, R. (2018). Chapter 9-Design Principles of Photovoltaic Irrigation Systems,\"Advances in Renewable Energies and Power Technologies\".","9.\tChang, C. (2016). Tracking solar collection technologies for solar heating and cooling systems. In Advances in solar heating and cooling (pp. 81-93). Woodhead Publishing.","10.\tChowdhury, K. I., Alam, M., & Bakshi, P. S. (2017). Performance comparison between fixed panel, single-axis and dual-axis sun tracking solar panel system (Doctoral dissertation, BARC University)."]}

Version 5 (v05) of the thermospheric wind data from the Michelson Interferometer for Global High-resolution Thermospheric Imaging (MIGHTI) instrument on the Ionospheric CONnections (ICON) mission has been recently released, which largely avoids local-time dependent artificial baseline drifts that are found in previous versions of the ICON/MIGHTI wind data. This paper describes monthly climatologies of zonal-mean winds and tides based on the v05 ICON/MIGHTI data under geomagnetically quiet conditions (Hp30 < 3o) during April 2020-March 2022. Green-line winds in the lower thermosphere (90-110 km) and red-line winds in the middle thermosphere (200-300 km) are analyzed, as these data cover both daytime and nighttime. The altitude and latitude structures of zonal-mean winds and tides are presented for each month, and the results are compared with the widely-used empirical model, Horizontal Wind Model 2014 (HWM14). The v05 wind retrieval algorithm does not involve HWM14. The ICON/MIGHTI and HWM14 results are in general agreement, providing a validation of the v05 ICON/MIGHTI data. The agreement is especially good for the zonal-mean winds. The tidal amplitudes in HWM14 are often too small compared with those from ICON/MIGHTI as well as previous studies. A more accurate description of tides in the thermosphere is key to the future improvement of HWM.

Background The methodology of measuring chronic subdural hematoma (cSDH) extent and its effect on intracranial structures is relevant for patient classification and outcome measurements and affects the external validity of cSDH studies. With embolization of the middle meningeal artery (MMA) as a possible treatment of cSDHs, the topic has gained substantial interest. We sought to summarize the heterogeneity of radiologic measurements, specifically in the evaluation of cSDHs based on literature review. Methods In this review, we identified and described the most common radiological methodologies for measurements of cSDH thickness, cSDH volume and of midline shift. Conclusion There are numerous published methods on how to evaluate cSDH thickness, cSDH volume and midline shift but no common standard. The definition of measurement methods and reporting standards for MMA embolization in cSDH patients and their validation needs to be addressed.

Background: Sepsis and septic shock are still associated with a high mortality rate. Early-stage prediction of septic shock outcomes would be helpful to clinicians for designing their treatment protocol. In addition, it would aid the clinicians in patient management by understanding gender disparity in terms of clinical outcomes of septic shock by identifying whether there are sex-based differences in sepsis-associated mortality. Objective: This study aimed to test the hypothesis that gender-based metabolic heterogeneity is associated with sepsis survival and identify the biomarkers of mortality for septic shock in the Indian cohort. Method: The study is performed in an Indian population cohort diagnosed with sepsis/septic shock within 24 hours of admission. The study group includes 50 patients admitted in intensive care, of which 23 are females, and 27 are males. Univariate and multivariate analysis is performed to identify biomarkers for septic shock mortality and gender-specific metabolic fingerprint in septic shock-associated mortality. Results: Energy-related metabolites, ketone bodies, choline, and NAG were primarily responsible for differentiating survivors and non-survivors. The gender-based mortality stratification identified female-specific association of anti-inflammatory response, innate immune response and β oxidation and male-specific association of pro-inflammatory response to septic shock. Conclusion: These identified mortality biomarkers may help estimate the severity of the case, predicting outcome and treatment efficacy. The study underlines that gender is one of the most significant biological factors influencing septic shock metabolomic profiles. This understanding can be utilized to identify novel gender-specific biomarkers and innovative targets relevant for gender medicine.

Purpose of the ReviewThis article reviews the Food and Drug Administration's (FDA’s) process for approval of new medical devices and describes the evolution of endovascular devices used for the treatment of acute ischemic stroke.Recent FindingsSeveral recent studies have established the benefit of endovascular treatment of acute ischemic stroke from emergent large vessel occlusion. This has led to endovascular treatment becoming the usual care in acute stroke management and has generated greater-than-ever interest in the development of newer and more effective devices.SummaryIn the United States, the FDA is the regulatory authority that is empowered with the approval and monitoring of new medical devices for widespread use in the population. The FDA categorizes medical devices into 3 classes based mainly on their potential risks to patients and/or users; class I devices pose the least risk and have the least stringent approval process, while class III devices pose the highest risk and undergo the most stringent and time-consuming approval process. There are 4 main pathways to approval: premarket notification, also known as the 510(k) pathway; premarket approval (PMA), de novo, and Humanitarian Device Exemption pathway. These pathways are described in detail in the article. The FDA also mandates postmarketing surveillance to identify any untoward and unexpected long-term complications.

An early metabolic signature associated with the responsiveness to treatment can be useful in the better management of septic shock patients. This would help clinicians in designing personalized treatment protocols for patients showing non-responsiveness to treatment.We analyzed the serum on Day 1 (n = 60), Day 3 (n = 47), and Day 5 (n = 26) of patients with septic shock under treatment using NMR-based metabolomics. Partial least square discriminant analysis (PLS-DA) was performed to generate the list of metabolites that can be identified as potential disease biomarkers having statistical significance (that is, metabolites that had a VIP score 1, and p value 0.05, False discovery rate (FDR) 0.05).Common significant metabolites amongst the three time points were obtained that distinguished the patients being responsive (R) and non-responsive (NR) to treatments, namely 3 hydroxybutyrate, lactate, and phenylalanine which were lower, whereas glutamate and choline higher in patients showing responsiveness.The study gave these metabolic signatures identifying patients' responsiveness to treatment. The results of the study will aid in the development of targeted therapy for ICU patients.

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Several studies have shown promising outcomes of the Woven EndoBridge (WEB) device for the treatment of wide-necked intracranial bifurcation aneurysms. This is a multicenter study attempts to explore the changes in trends and treatment outcomes over time for WEB embolization of intracranial aneurysms. The WorldWideWEB consortium is a retrospective multicenter collaboration of data from international centers spanning from January 2011 and June 2021, with no limitations on aneurysm location or rupture status. Both bifurcation and sidewall aneurysms were included. These patients were stratified based on treatment year into five treatment intervals: 2011-2015 (N = 66), 2016-2017 (N = 77), 2018 (N = 66), 2019 (N = 300), and 2020-2021 (N = 173). Patient characteristics and angiographic and clinical outcomes were compared between these time intervals. This study comprised 671 patients (median age 61.4 years; 71.2% female) with 682 intracranial aneurysms. Over time, we observed an increasing tendency to treat patients presenting with ruptured aneurysms and aneurysms with smaller neck, diameter, and dome widths. Furthermore, we observed a trend towards more off-label use of the WEB for sidewall aneurysms and increased adoption of transradial access for WEB deployment. Moreover, the proportion of patients with adequate WEB occlusion immediately and at last follow-up was significantly higher in more recent year cohorts, as well as lower rates of compaction and retreatment. Mortality and complications did not differ over time. This learning curve study suggests improved experience using the WEB for the treatment of intracranial aneurysms and has yielded higher rates of adequate occlusion over time.

BackgroundThe mechanisms and outcomes in coronavirus disease (COVID-19)-associated stroke are unique from those of non-COVID-19 stroke.ObjectiveTo describe the efficacy and outcomes of acute revascularization of large vessel occlusion (LVO) in the setting of COVID-19 in an international cohort.MethodsWe conducted an international multicenter retrospective study of consecutively admitted patients with COVID-19 with concomitant acute LVO across 50 comprehensive stroke centers. Our control group constituted historical controls of patients presenting with LVO and receiving a mechanical thrombectomy between January 2018 and December 2020.ResultsThe total cohort was 575 patients with acute LVO; 194 patients had COVID-19 while 381 patients did not. Patients in the COVID-19 group were younger (62.5 vs 71.2; P < .001) and lacked vascular risk factors (49, 25.3% vs 54, 14.2%; P = .001). Modified thrombolysis in cerebral infarction 3 revascularization was less common in the COVID-19 group (74, 39.2% vs 252, 67.2%; P < .001). Poor functional outcome at discharge (defined as modified Ranklin Scale 3-6) was more common in the COVID-19 group (150, 79.8% vs 132, 66.7%; P = .004). COVID-19 was independently associated with a lower likelihood of achieving modified thrombolysis in cerebral infarction 3 (odds ratio [OR]: 0.4, 95% CI: 0.2-0.7; P < .001) and unfavorable outcomes (OR: 2.5, 95% CI: 1.4-4.5; P = .002).ConclusionCOVID-19 was an independent predictor of incomplete revascularization and poor outcomes in patients with stroke due to LVO. Patients with COVID-19 with LVO were younger, had fewer cerebrovascular risk factors, and suffered from higher morbidity/mortality rates.

Diagnosis and management of patients with septic shock is still a significant challenge for clinicians with its high mortality amongst hospitalized patients. Septic shock is a heterogeneous condition and is usually accompanied by various underlying disease conditions. Dissecting the specific metabolic changes induced by these underlying disease conditions through metabolomics has shown the potential to improve our understanding of the disease's relevant pathophysiological mechanisms, leading to improved treatment. This study has shown the metabolic alterations caused due to co-morbid conditions like diabetes, hypertension, CAD, and CKD in septic shock. It has also shown the distinct metabolic profiles of septic shock patients with underlying respiratory illnesses and encephalopathy. Metabolic profiling of sera obtained from 50 septic shock patients and 20 healthy controls was performed using high-resolution 1D 1H CPMG and diffusion-edited NMR spectra. Univariate and multivariate statistical analyses were performed to identify the potential molecular biomarkers. Noted dysregulations in amino acids, carbohydrates, and lipid metabolism were observed in septic shock patients. Further stratification within the septic shock patients based on co-morbid conditions and primary diagnosis has shown their role in causing metabolic alterations. Evaluation of these compounds during treatment will help design a personalized treatment protocol for the patients, improving therapeutics.

In this study, the variability of migrating solar diurnal (DW1) tide in the mesosphere-lower thermosphere (MLT) region during Northern and Southern Hemisphere (NH & SH) Sudden Stratospheric Warmings (SSWs) is investigated using Sounding of the Atmosphere using Broadband Emission Radiometry (SABER) temperature observations and reanalysis-driven Whole Atmosphere Community Climate Model with thermosphere and ionosphere extension (WACCM-X) simulations. The periods examined include four major NH SSWs that occurred during January in 2006, 2009, 2010 and 2013 and two SH SSWs that were recorded in September in 2002 and 2019. Our analysis shows that the observed DW1 tide displays a marked decline in the equatorial region after the onset of NH and SH SSWs. As WACCM-X simulations qualitatively reproduce this feature of DW1 tidal variability common to both NH and SH SSWs, they have been used to examine the possible mechanism that could explain these observations in DW1 tide. It is known that changes in the latitudinal shear of zonal winds at low-latitudes strongly affect the seasonal variation of DW1 tide in the MLT. We explore this mechanism to show that SSW-associated changes in the latitudinal shear in the MLT could be used to explain the observed variability of DW1 tide during NH and SH SSWs.

Significant advances in the field of carotid artery stenting (CAS) have occurred, including new randomized trial data, recent professional societal statements for competency, new techniques and new devices that have been developed, and perhaps most importantly, our understanding of how to better select candidates for CAS to avoid periprocedural complications. The current Centers for Medicare and Medicaid Services coverage decision regarding CAS is outdated, and our review supports our recommendation to approve CAS in selected candidates who are symptomatic with a carotid stenosis ≥50% and ≤99% and for asymptomatic patients with carotid stenosis ≥70% and ≤99% for stroke prevention. Optimized CAS strategies have allowed experienced operators to better assess procedure risk before CAS and have led to continued improvement in CAS outcomes. New technologies including enhanced embolic protection devices and dual-layered stents should result in further improvement.

Evaluation of chronic subdural hematoma (cSDH) treatment success relies on radiologic measures, in particular hematoma volume, width and midline shift (MLS). Nevertheless, there are no validated standards for MLS measurement in cSDH. Aim of this study was to identify the most reliable measurement location and technique for MLS.Admission CT scans of 57 patients with unilateral cSDH were retrospectively analyzed. Axial slices were evaluated by 4 raters with MLS measurement in 4 locations, foramen of Monro (FM), thalamus (Th), mid-septum pellucidum (SP), maximum overall MLS (max) with 2 different techniques: displacement perpendicular to anatomical (ideal) midline (MLS-M), and displacement relative to the tabula interna in relation to the width of the intracranial space (MLS-T). Intraclass correlation coefficients (ICC) were calculated to assess interrater reliability and agreement of MLS‑M and MLS‑T measurement techniques. Measurements of cSDH volume and width were conducted for further data alignment.The ICCs between readers were excellent ( 0.9) for all MLS‑M locations and for MLS-T_Th and ML-T_FM. The ICC was higher for MLS‑M than for MLS‑T in all locations. MLS-M_max showed the highest correlation coefficient of 0.78 with cSDH volume. Variance of MLS-M_max was explained in 64% of cases (adj. R squared) by cSDH volume based on a simple linear regression model. An increase of 10 ml cSDH volume resulted in an average increase of 0.8 mm MLS-M_max.The MLS measurement in cSDH patients should be standardized, and due to its high interrater reliability, the MLS‑M technique should be preferred.

HIV-1 replicates in cells that express a wide array of innate immune sensors and may do so simultaneously with other pathogens. How a coexisting innate immune stimulus influences the outcome of HIV-1 sensing, however, remains poorly understood. Here, we demonstrate that the activation of a second signaling pathway enables a cyclic GMP-AMP synthase (cGAS)-dependent type I interferon (IFN-I) response to HIV-1 infection. We used RNA sequencing to determine that HIV-1 alone induced few or no signs of an IFN-I response in THP-1 cells. In contrast, when supplemented with suboptimal levels of bacterial lipopolysaccharide (LPS), HIV-1 infection triggered the production of elevated levels of IFN-I and significant upregulation of interferon-stimulated genes. LPS-mediated enhancement of IFN-I production upon HIV-1 infection, which was observed in primary macrophages, was lost by blocking reverse transcription and with a hyperstable capsid, pointing to viral DNA being an essential immunostimulatory molecule. LPS also synergistically enhanced IFN-I production by cyclic GMP-AMP (cGAMP), a second messenger of cGAS. These observations suggest that the DNA sensor cGAS is responsible for a type I IFN response to HIV-1 in concert with LPS receptor Toll-like receptor 4 (TLR4). Small amounts of a TLR2 agonist also cooperate with HIV-1 to induce type I IFN production. These results demonstrate how subtle immunomodulatory activity renders HIV-1 capable of eliciting an IFN-I response through positive cross talk between cGAS and TLR sensing pathways. IMPORTANCE Innate immune activation is a hallmark of HIV-1 pathogenesis. Thus, it is critical to understand how HIV-1 infection elicits innate immune responses. In this work, we show that HIV-1 infection of macrophages leads to a robust type I interferon (IFN) production only when a second signaling event is initiated by a coexisting immunostimulatory molecule. Our results show that HIV-1 infection alone is not sufficient for triggering a strong IFN response. We find that bacterial membrane components, which are recognized by endosomal innate sensors, enable production of elevated levels of IFNs and significant upregulation of interferon-stimulated genes upon HIV-1 infection. This IFN response is dependent on viral DNA synthesis and prevented by a stable capsid, pointing to an essential role for a DNA sensing molecule. These observations provide new insights into how different innate immune recognition pathways synergize during HIV-1 infection and determine the outcome of innate responses.

Endovascular therapy became the mainstream treatment for patients with acute stroke due to emergent large vessel occlusion (LVO). With increasing number of interventions, it is not uncommon for incidental vascular pathologies to be found during mechanical thrombectomy. Overall, intracranial aneurysms can occur in up to 4% of the population, but previous studies suggest a slightly higher prevalence of intracranial aneurysms in stroke patients as they may share common risk factors. We report on three patients with acute stroke secondary to LVO undergoing mechanical thrombectomy with brain aneurysms incidentally discovered and discuss the potential implications and technical considerations of performing revascularization in these scenarios. In the first case, a patient treated with stent-retriever and aspiration developed a carotid-cavernous fistula without clinical repercussion. The second case illustrates an internal carotid artery posterior communicating segment aneurysm rupture with a massive subarachnoid hemorrhage. The third case exemplifies an unruptured middle cerebral artery bifurcation aneurysm related to an M2 occlusion managed with a different strategy, avoiding aneurysm rupture. Intraprocedural aneurysm rupture is a potential complication during mechanical thrombectomy, especially when anatomical challenges are present. Interventionalists should be aware of the potential risk and constraints in this setting in order to mitigate adverse events.

This meeting abstract was removed due to the OA licensing requirements of this journal. The full abstract is listed here : https://www.svin.org/files/SVIN_2021_Abstracts_for_Web.pdf

OBJECTIVE Transradial access (TRA) is commonly utilized in neurointerventional procedures. This study compared the technical and clinical outcomes of the use of TRA versus those of transfemoral access (TFA) for intracranial aneurysm embolization with the Woven EndoBridge (WEB) device. METHODS This is a secondary analysis of the Worldwide WEB Consortium, which comprises multicenter data related to adult patients with intracranial aneurysms who were managed with the WEB device. These aneurysms were categorized into two groups: those who were treated with TRA or TFA. Patient and aneurysm characteristics and technical and clinical outcomes were compared between groups. Propensity score matching (PSM) was used to match groups according to the following baseline characteristics: age, sex, subarachnoid hemorrhage, aneurysm location, bifurcation aneurysm, aneurysm with incorporated branch, neck width, aspect ratio, dome width, and elapsed time since the last follow-up imaging evaluation. RESULTS This study included 682 intracranial aneurysms (median [interquartile range] age 61.3 [53.0–68.0] years), of which 561 were treated with TFA and 121 with TRA. PSM resulted in 65 matched pairs. After PSM, both groups had similar characteristics, angiographic and functional outcomes, and rates of retreatment, thromboembolic and hemorrhagic complications, and death. TFA was associated with longer procedure length (median 96.5 minutes vs 72.0 minutes, p = 0.006) and fluoroscopy time (28.2 minutes vs 24.8 minutes, p = 0.037) as compared with TRA. On the other hand, deployment issues were more common in those treated with TRA, but none resulted in permanent complications. CONCLUSIONS TRA has comparable outcomes, with shorter procedure and fluoroscopy time, to TFA for aneurysm embolization with the WEB device.