BACKGROUND AND PURPOSE:Spontaneous intracranial hypotension (SIH) with ventral dural tears is associated with spinal longitudinal extradural collections (SLECs). Direct fluoroscopic characterization of the anterior epidural compartment and SLEC morphology in vivo remains limited. We describe wire-catheter epidural navigation and imaging in patients with SIH and SLECs. METHODS:Between June 2023 and December 2025, 20 consecutive patients with type 1 SIH and MRI-confirmed SLECs underwent attempted wire-catheter epidural navigation from a lumbar interlaminar approach. Using a hydrophilic guidewire and 4 French catheter, a controlled dorsoventral transition was performed to access the anterior epidural space. Feasibility of anterior epidural and SLEC cannulation was assessed. Therapeutic outcomes were not evaluated. RESULTS:Anterior epidural and/or SLEC opacification was successfully obtained in 15/20 cases (75%, 95% CI 51% to 91%). Anterior epidural injections demonstrated a segmental pattern with radiolucent septations and periradicular extensions, whereas SLEC injections produced homogeneous ventral opacification without segmental organization. Navigation failed in 5 cases due to dense epidural scarring (n=2) or early procedural discontinuation related to concern for dural violation (n=3). Venous entry occurred in approximately 15-25% of procedures. One early case of subarachnoid opacification resulted in transient symptoms that resolved with conservative management. CONCLUSIONS:Epidural navigation enables fluoroscopic access to the anterior epidural space and SLECs in patients with SIH. Imaging patterns, metameric septations in the anterior epidural space, and homogeneous opacification in SLECs correspond to anatomical structures and distinguish between different compartments. These technical and anatomical observations provide a foundation for therapeutic applications.

BACKGROUND:Transradial access (TRA) has become an integral component of contemporary neurointerventional practice, offering reduced access site complications and improved patient comfort compared with transfemoral approaches. However, anatomical constraints intrinsic to the radial route continue to define the physiological boundaries of radial first strategies, underscoring the need for guide catheters that balance navigability, support, and access site safety. The Benchmark BMX81 guide catheter represents a radial compatible platform designed to address these challenges, but large multicenter data within a standardized radial first framework remain limited. METHODS:We conducted a multicenter, retrospective observational study across nine high volume European neurointerventional centers. Adult patients undergoing neuroendovascular procedures in which the BMX81 was selected as the primary guide catheter via a radial first strategy were included. Technical success was defined as completion of the planned procedure using transradial access. Access conversion and procedural abortion were analyzed within a safety oriented radial first framework. Complications were assessed descriptively. RESULTS:A total of 300 patients (mean age 64 years; 58.3% women) were included. Technical success was achieved in 289 cases (96.3%). Radial-to-femoral access conversion occurred in four cases (1.3%), and seven procedures (2.3%) were aborted. Neither conversion nor procedural abortion was attributable to intrinsic guide catheter failure but consistently reflected predefined anatomical constraints, including unfavorable great vessel geometry and severe proximal tortuosity. Access related complications were infrequent and predominantly minor, including radial artery spasm (1.7%), minor forearm hematoma (5.3%), and asymptomatic radial artery occlusion (3.3%). No guide catheter entrapment, procedure related stroke, or mortality was observed. CONCLUSIONS:Within a mature radial first neurointerventional strategy, the BMX81 demonstrated high technical success and a favorable safety profile across a broad spectrum of procedures. These findings support a strategy driven interpretation of transradial outcomes, in which guide catheter performance reflects the interaction between anatomy, access strategy, and device design rather than an isolated technical attribute. The BMX81 appears to be a reliable platform when applied within anatomically informed radial first practice.

Flow diverters (FDs) are increasingly used for cerebral aneurysms, including distal anterior cerebral artery (DACA) aneurysms, but comparative data between devices in this challenging location are limited. To compare the safety and efficacy of Pipeline, Silk Vista Baby (SVB), and FRED Jr. FDs for unruptured DACA aneurysms and identify predictors of complete occlusion. We retrospectively analyzed 166 patients treated with FDs at 39 centers in 14 countries (2018–2022) from the CRETA registry. Outcomes included aneurysm occlusion (O’Kelly–Marotta [OKM] scale), complications, retreatment, modified Rankin Scale (mRS) scores, and independent predictors of complete occlusion using multivariable Cox regression. Aneurysms were predominantly saccular and located on the pericallosal artery. Complete occlusion (OKM D) was achieved in 73

Duropathies represent a spectrum of disorders associated with spinal dural tears and cerebrospinal fluid (CSF) leaks. Diagnosis and treatment is often complicated by overlapping clinical manifestations. This review aims to synthesize current literature on duropathies, focusing on their clinical, neuroradiological, and pathophysiological features. A comprehensive literature review was conducted, analyzing various conditions classified as duropathies, including spontaneous intracranial hypotension (SIH), superficial siderosis (SS), spinal cord herniation, and, as added issue, arachnoid webs. The review emphasized the importance of imaging techniques such as MRI and CT myelography in diagnosing these conditions. Duropathies can arise from congenital anomalies, trauma, and degenerative changes, with SIH being characterized by orthostatic headaches and neurological deficits. Imaging typically reveals specific patterns, such as a widened dorsal subarachnoid space and ventral displacement of the spinal cord. Syringomyelia was frequently associated with arachnoid webs, and complications like SS and bibrachial amyotrophy were noted in patients with persistent ventral spinal CSF leaks. The unifying concept of duropathies is proposed, emphasizing the need for timely intervention to mitigate long-term neurological consequences. Enhanced diagnostic strategies are crucial for improving patient outcomes, and a multidisciplinary approach is recommended for the management of these complex disorders. Further research is warranted to clarify the pathophysiological mechanisms underlying duropathies and to establish standardized treatment protocols.

A rare extra- and intracranial mixed vascular malformation involving the scalp soft tissues and the dura mater, associated with skull erosion, and characterized by both a low-flow capillary-venous component and a high-flow component consistent with a dural arteriovenous fistula involving a diploic vein, represents a complex therapeutic challenge. An 18-year-old man underwent multimodal imaging for evaluation of non-disabling headaches and intermittent pulsatile sensation. MRI and CT demonstrated focal calvarial erosion, while MRA and digital subtraction angiography revealed a direct shunt between the middle meningeal artery and a diploic vein, in addition to a diffuse low-flow capillary-venous network supplied by branches of the external carotid artery and the middle meningeal artery. Treatment consisted of selective embolization of the shunt using n-butyl cyanoacrylate, followed by intra-arterial bleomycin administration combined with reversible electroporation targeting the slow-flow component. At 6-month follow-up, the patient was asymptomatic, with only localized alopecia at electrode application sites. Follow-up MRI demonstrated near-complete resolution of the dural component and marked reduction of the extracranial lesion, indicating a favorable clinical and radiological outcome.

Introduction: Intracranial stenting during endovascular thrombectomy (EVT) is a common practice in the setting of failed reperfusion or severe stenosis. Immediate stent patency requires periprocedural antiplatelet therapy (APT). How APT intensity interacts with prior intravenous thrombolysis (IVT) to influence hemorrhagic risk remains uncertain. We aimed to assess whether the APT regimen modifies the association of IVT with early intracranial hemorrhage after intracranial stenting during EVT. Methods: This was a subanalysis of the RESISTANT registry, a multicenter, international, retrospective cohort (2016 to 2023) of adults with acute ischemic stroke who underwent intracranial stenting during EVT. APT regimens were categorized as conservative (intravenous or oral aspirin alone, or aspirin plus an oral P2Y12 inhibitor) and aggressive (any regimen including intravenous GPIIb/IIIa inhibitor or intravenous cangrelor). Four main groups were compared according to the APT regimen (conservative/aggressive) and the use of IVT (+/-). The primary outcome was a composite of sICH and parenchymal hematoma types 1 and 2 (sICH-PH2-PH1). Multivariable logistic regression models were used to evaluate the interaction between IVT and APT, adjusting for clinically relevant covariates. Results: Among the 823 included patients, 44 (5.3%) received conservative APT with IVT, 130 (15.8%) received conservative APT without IVT, 145 (17.6%) received aggressive APT with IVT, and 504 (61.2%) received aggressive APT without IVT. Among patients who received IVT, sICH-PH2-PH1 rates were 9.3% with conservative APT and 10.7% with aggressive APT; among those without IVT, rates were 3.2% and 9.9%, respectively. Administration of IVT (adjusted odds ratio [aOR] 5.84, 95%CI 1.07 to 43.92; p=0.05) and aggressive APT (aOR 4.81, 95% CI 1.41 to 30.22; p=0.03) were each associated with higher odds of hemorrhagic complications, with a significant IVT by APT interaction (P interaction =0.05; Figures 1 and 2 ). Within the aggressive APT plus IVT subgroup, sICH-PH2-PH1 occurred in 20% of patients treated with cangrelor and 6.1% treated with a glycoprotein IIb/IIIa inhibitor ( Figure 3 ). Conclusion: Among patients requiring intracranial stenting, aggressive periprocedural APT and prior IVT are each associated with higher hemorrhagic risk, with the combination showing the worst observed crude outcome. Prospective evaluation of protocolized APT pathways in the IVT setting is warranted.

BACKGROUND AND OBJECTIVE:Flow diverter devices have revolutionized the treatment of intracranial aneurysms, but evidence on newer-generation devices remains limited. The Surpass Evolve (SE) was designed to improve deliverability and vessel wall apposition compared with its predecessors. This registry aimed to evaluate the feasibility, safety, and efficacy of SE in a large, real-world multicenter cohort with long-term follow-up. METHODS:Between May 2019 and December 2022, 275 consecutive aneurysms in 272 patients were treated with the SE flow diverter across 28 Italian centers. Clinical and imaging follow-up was completed by January 2024. Mid-term (≤6 months) and long-term (≤24 months) follow-ups, including clinical assessment, angiography, and cross-sectional imaging (computed tomography/magnetic resonance), were systematically collected and independently reviewed by a central Core Lab. RESULTS:The mean maximum diameter of the aneurysm was 11.2 mm, and the mean neck size was 5.4 mm. A total of 258 aneurysms were unruptured (93.8%), and 17 (6.2%) were ruptured. The majority arose from the anterior circulation (87.6%), with 12.4% in the posterior circulation. Device deployment was unsuccessful in 5/278 procedures (1.8%), and misdeployment occurred in 28/278 (10%). The overall device-related mortality was 0.7%, and the morbidity was 5.4%. At mid-term follow-up, complete or near-complete occlusion was achieved in 66% of aneurysms, increasing to 92% at long-term. According to mass criteria, 82% of aneurysms were considered cured, whereas sac enlargement occurred in 0.5% and 17% remained unchanged in volume. CONCLUSION:Our experience using SE for endovascular treatment of intracranial aneurysms showed a high safety and efficacy profile, substantially equivalent to that of the other flow diverter devices commonly used.

BACKGROUND:Mechanical thrombectomy (MT) is effective for acute basilar artery occlusion (BAO), but the optimal technique for rapid recanalization and improved outcomes remains unclear. OBJECTIVE:We compared stent retriever (SR), contact aspiration (CA), and combined SR plus CA techniques as first-line approaches during MT for BAO. METHODS:We emulated a hypothetical trial comparing CA, SR, and combined technique as first-line in BAO patients. The primary outcome was first-pass effect (FPE), defined as modified Thrombolysis in Cerebral Infarction (mTICI) 3 with one pass of MT. Secondary outcomes included modified FPE (mFPE), functional outcome at 90 days, successful recanalization, and safety outcomes. We used inverse probability weighting (IPW) adjusted for prespecified covariates. RESULTS:The study included 960 BAO patients: 570 treated with CA, 268 with SR, and 122 with combined technique as the first approach. After applying IPW, SR was associated with lower odds of FPE (adjusted OR (aOR) 0.62, 95% CI 0.43 to 0.90) and of mFPE (aOR 0.48, 95% CI 0.33 to 0.70) compared with CA. No differences were found between the combined technique and either SR or CA. A 90-day modified Rankin Scale (mRS) 0-3 after mFPE was less frequent with SR (aOR 0.57, 95% CI 0.38 to 0.85) and with combined technique (aOR 0.50, 95% CI 0.28 to 0.89) compared with CA. Additionally, combined technique showed lower odds of mRS 0-1 at 90 days compared with CA (aOR 0.56, 95% CI 0.33 to 0.94). CONCLUSIONS:In BAO patients, CA was more effective than SR for complete and successful recanalization after first pass and resulted in better outcomes after mFPE as compared with other techniques. Less traumatic approaches might be preferred as first-line in BAO.

BACKGROUND:The different pathophysiological mechanisms leading to tandem occlusion (TO), namely arterial dissection or atherosclerosis, may have an impact on the outcome of patients with acute ischemic stroke (AIS) undergoing endovascular thrombectomy (EVT). METHODS:Consecutive AIS patients with occlusion of the cervical internal carotid artery and concomitant intracranial large vessel occlusion who received EVT between 2011 and 2023 as part of the Italian Registry of Endovascular Treatment in Acute Stroke (IRETAS) were deemed eligible. We compared clinical and radiological outcomes of patients with dissecting TO versus atherosclerotic TO by the propensity score matching approach. RESULTS:Overall, 2148 patients (mean age 69.3±12.8 years; males 64.5%) qualified for the analysis. Of these, 236 (10.9%) had dissecting TO, and 1912 (89.1%) atherosclerotic TO. As expected, patients with dissecting TO stroke were younger and had a lower burden of major cardiovascular risk factors. In the matched cohort, we observed no difference between the two groups in either 90-day functional independence (OR 1.33; 95% CI 0.94 to 1.83; p=0.115) or in any of the secondary endpoints, except for a reduced risk of parenchymal hematoma type 2 (OR 0.37; 95% CI 0.14 to 0.98; p=0.046) in the group of patients with dissecting TO stroke, which, however, did not affect patient outcome. CONCLUSIONS:The outcome of patients undergoing EVT because of dissecting TO stroke does not differ from that of patients with atherosclerotic TO stroke. The etiology of the underlying vascular lesion should not be regarded as a contraindication to EVT procedures in these cases.

BACKGROUND:Flow diversion is effective for unruptured distal anterior cerebral artery (DACA) aneurysms, yet comparative data between the Silk Vista Baby (SVB) and Pipeline Embolization Device (PED) in this challenging territory remain scarce. METHODS:We conducted a retrospective multicenter study using the CRETA Registry, including consecutive patients with unruptured DACA aneurysms treated with SVB or PED. The primary endpoint was complete angiographic occlusion (O'Kelly-Marotta grade D). Secondary outcomes included procedural characteristics, clinical outcome (modified Rankin Scale), and complications. Overlap weighting was applied to account for non-randomized treatment allocation. Predictors of occlusion were explored using penalized logistic regression. A sensitivity analysis using a reduced five-variable model was performed to assess model robustness. RESULTS:137 patients were included (79 SVB, 58 PED). Within the PED group, devices included Pipeline Flex (n = 34), Pipeline Flex with Shield Technology (n = 14), and Pipeline Vantage with Shield Technology (n = 10). After overlap weighting, baseline characteristics were balanced; the effective sample size was 100.4. SVB procedures more often used a single device; PED frequently required multiple stents. Procedure duration was shorter with SVB. Complete occlusion was achieved in 69.6% (SVB) and 70.7% (PED) of aneurysms, with no significant difference in adjusted analysis (OR 1.32, 95% CI 0.59-2.96). Favorable clinical outcomes were observed in both groups, with acceptable and comparable complication rates. No variable, including device type, independently predicted complete occlusion, a finding confirmed in a reduced five-variable sensitivity analysis (aOR 1.04, 95% CI 0.47-2.31; p = 0.915). CONCLUSIONS:SVB and PED demonstrated comparable angiographic efficacy and clinical safety for unruptured DACA aneurysms. Despite procedural differences, mid-term occlusion rates and outcomes were similar. Device selection in this distal territory may be guided primarily by anatomical considerations and operator preference rather than expectations of differential performance.

The optimal revascularization treatment in patients with acute ischemic stroke (AIS) and isolated extracranial artery occlusion remains uncertain. We aimed to compare outcomes between endovascular treatment (EVT) and intravenous thrombolysis (IVT) alone in patients with AIS and isolated extracranial artery occlusion without concomitant ipsilateral large intracranial occlusion treated ≤ 4.5 h of onset. We retrospectively analyzed prospectively collected data from two multicenter registries (IRETAS for EVT and SITS-ISTR for IVT). Primary efficacy endpoints were 3-month modified Rankin Scale (mRS) score 0–1 and 0–2. Primary safety endpoints were symptomatic intracranial hemorrhage (sICH) and 3-month mortality. Multivariable logistic regression was used to adjust for imbalances in demographics, clinical variables, stroke etiology data, and procedure data. A total of 793 patients were included in the study (EVT, n = 358; IVT alone, n = 389; control angiography, n = 46), of whom 633 with extracranial internal carotid artery (ICA) occlusion and 160 with extracranial vertebral artery (VA) occlusion. In the isolated extracranial ICA or VA occlusions, EVT was associated with lower rates of mRS 0–1 (aOR: 0.45, 95

Background Current clinical decision tools for assessing the risk of symptomatic intracranial hemorrhage (sICH) in patients with vertebrobasilar artery occlusion (VBAO) who received endovascular treatment (EVT) have limited performance. This study develops and validates a clinical risk score to precisely estimate the risk of sICH in VBAO patients.Methods The derivation cohort recruited patients with VBAO who received EVT from the Posterior Circulation IschemIc Stroke Registry in China. Based on the posterior circulation-Alberta Stroke Program Early CT Score (pc-ASPECTS) evaluation method, the cohort was further divided into non-contrast CT (NCCT) and diffusion weighted imaging (DWI) cohorts to construct predictive models. sICH was diagnosed according to the Heidelberg Bleeding Classification within 48 hours of EVT. Clinical signature was constructed in the derivation cohort using machine learning and was validated in two additional cohorts from Asia and Europe.Results We enrolled 1843 patients who underwent EVT and had complete data. pc-ASPECTS of 1710 patients was evaluated on NCCT and 699 patients on DWI. In the NCCT cohort, 1364 individuals made up the training set, of whom 101 (7.4%) developed sICH. In the DWI cohort, the training set consisted of 560 individuals, with 44 (7.9%) experiencing sICH. Predictors of sICH were: glucose, pc-ASPECTS, time from estimated occlusion to groin puncture (EOT), poor collateral circulation, and modified Thrombolysis in Cerebral Infarction (mTICI) score. From these predictors, we derived the weighted poor collateral circulation-EOT-pc-ASPECTS-mTICI-glucose (PEACE) score. The PEACE score showed good discrimination in the training set (area under the curve (AUC)NCCT=0.85; AUCDWI=0.86), internal validation set (AUCNCCT=0.81; AUCDWI=0.82), and two additional external validation set (Asia: AUCNCCT=0.78, AUCDWI=0.80; Europe: AUCNCCT=0.74, AUCDWI=0.78).Conclusion The PEACE score reliably predicted the risk of sICH in VBAO patients who underwent EVT.

BACKGROUND:While rescue stenting (RS) is a recognized bailout strategy following failed endovascular thrombectomy for acute ischemic stroke with large vessel occlusion, first-line stenting (FLS) has emerged as a potential alternative to avoid vascular injury and improve outcomes. However, direct comparisons between these strategies remain limited. We conducted a comparative analysis of FLS versus RS using data from a large, multicenter international registry to evaluate their relative safety and effectiveness. METHODS:We conducted a comparative analysis of FLS versus RS using data from the RESISTANT registry (Registry of Endovascular Salvage for Intracranial Stenting in Thrombectomy-Refractory Stroke), a multicenter, international, retrospective cohort of patients with acute ischemic stroke treated with intracranial stenting during endovascular thrombectomy (2016-2023). Patients were categorized by stenting strategy: FLS (stent placed without prior thrombectomy) or RS (stent placed after failed thrombectomy). The primary effectiveness outcome was functional independence (modified Rankin Scale score, 0-2) at 90 days; the primary safety outcome was symptomatic intracranial hemorrhage. Propensity score inverse probability of treatment weighting was used to adjust for baseline differences. RESULTS:Among 827 patients, 723 were in the RS cohort (median age, 67 [interquartile range, 59-77] years; 64.2% male) and 104 in the FLS cohort (median age, 65.5 [interquartile range, 58.8-77] years; 72.1% male). Using FLS as the reference strategy, inverse probability of treatment weighting-adjusted analyses did not detect significant differences in functional independence (odds ratio [OR], 0.64 [95% CI, 0.38-1.07]) or symptomatic intracranial hemorrhage (OR, 0.93 [95% CI, 0.34-2.59]). No significant differences were observed in secondary outcomes, including successful reperfusion, mortality, or procedural complications. In the anterior circulation cohort (n=589), outcomes were likewise comparable (functional independence: OR, 0.62 [95% CI, 0.60-1.25]; symptomatic intracranial hemorrhage: OR, 0.81 [95% CI, 0.30-2.18]). Similarly, in the posterior circulation cohort (n=234), no significant differences were found (functional independence: OR, 0.82 [95% CI, 0.32-2.10]; symptomatic intracranial hemorrhage: OR, 0.81 [95% CI, 0.30-2.18]). CONCLUSIONS:In this study, no significant differences in safety or effectiveness were detected between FLS and RS strategies during endovascular thrombectomy for acute ischemic stroke. Prospective, randomized trials are needed to better define optimal treatment approaches.

Hemorrhagic isolated aneurysms of the lateral or medial lenticulostriate arteries (LLSA/MLSA) are rare; evidence is limited to case reports and small series, so the benefit of treatment versus conservative management is uncertain. We reviewed published hemorrhagic isolated (non–malformation-associated) LLSA/MLSA aneurysms, extracting demographics, imaging presentation/aneurysm size, Hunt–Hess grade, management, complications/rebleeding, aneurysm status, mRS. Patients were grouped as treated (surgery/endovascular/radiosurgery) or conservative and compared with exact tests. Three additional conservatively managed cases are described. Forty-two publications reported 48 patients (median age 41.5; 24 men/23 women; 1 unreported). LLSA aneurysms predominated (37/48). Presentation: ICH 34/48, IVH 24/48, isolated SAH 7/48. Twenty-eight patients were treated (22 surgery, 5 endovascular, 1 radiosurgery) and 20 managed conservatively. Conservative patients had higher Hunt–Hess grades (median 4 vs 3) and none had isolated SAH. Rebleeding occurred in 3/20 (15

BACKGROUND:Nearly half of the patients who received endovascular thrombectomy (EVT) for large vessel occlusion experience poor functional outcomes. Reliable tools for early post-procedural prognostication are needed. We aimed to assess and compare the performance of existing, pragmatic post-EVT prognostic scores in a large national multicenter cohort. METHODS:We conducted a systematic literature search to identify pragmatic post-thrombectomy prognostic scores predicting 90-day functional outcomes. Models relying on advanced imaging, small derivation samples, or machine learning were excluded. We analyzed data from the IRETAS registry-a prospective, multicenter Italian cohort of stroke patients treated with EVT. Inclusion criteria were pre-stroke modified Rankin Scale (mRS) ⩽ 2 and available 90-day mRS. The primary outcome was good functional outcome (mRS ⩽ 2). Prognostic performance was assessed using c-statistics in the samples where each individual score was measurable. Scores were compared using DeLong tests in the subset of patients for whom all scores were measurable. RESULTS:Three scores were identified: HERMES-24, BET, and SNARL. Among 22,768 patients in the registry, 18,408 (89.1%) had a measurable HERMES-24 score, 13,593 (59.7%) had a measurable BET score, and 19,007 (83.5%) had a measurable SNARL score. Median age was 75 years (IQR 65-82), and 11,528 (50.6%) were female. In the subset in which each test was measurable, HERMES-24 showed the best performance for predicting mRS ⩽ 2 (c-statistic = 0.889), followed by BET (c-statistic = 0.794) and SNARL (c-statistic = 0.762) (p < 0.001). In the subset of 12,233 patients for whom all three prognostic scores were calculable, a head-to-head comparison confirmed the superior performance of the HERMES-24 model: HERMES-24 score versus BET score (c-statistic difference = 0.098 [95% CI = 0.092-0.105]; p < 0.001) and HERMES-24 score versus SNARL score (c-statistic difference = 0.124 [95% CI = 0.116-0.132]; p < 0.001). CONCLUSIONS:In this large, multicenter, national cohort, the post-EVT HERMES-24 score-which accounts only for age and 24-h NIHSS-demonstrated the highest prognostic performance among existing, pragmatic post-EVT scores. Its simplicity and robust performance support its routine adoption in clinical practice.

BackgroundMechanical thrombectomy is the standard of care for acute ischemic stroke due to large vessel occlusion. Choosing a transradial approach (TRA) for anterior circulation occlusions is a matter of debate. The use of a triaxial 7F low-profile system could help mitigate numerous issues related to transradial MT.MethodsFrom 10/2022 to 7/2025, 111 patients underwent TRA-MT for anterior circulation LVOs, both as first-line and as rescue from transfemoral access failure, with the same setup (7F sheath, 7F guide catheter, and aspiration catheters ranging from 062 in. to 043 in. in relation to occlusion site). Choice of thrombectomy technique was at the operator's discretion. Patients' demographic data, clinical presentation, treatment details, complications, rate of TFA crossover, successful reperfusion (mTICI score ≥2b), and good clinical outcome at 3 months (mRS 0-2) were reported.ResultsOf 111 patients, 66 (50%) had occlusion of the M1 MCA, 20 (18%) of the internal carotid artery termination, and 23 (20.7%) of the M2 MCA. Right-sided occlusions were 56/111 (50.5%) and left-sided 56/111 (49.6%). Median patients' age was 80 years, and median NIHSS score was 17 at admission. Successful reperfusion (mTICI ≥2b) was achieved in 103/111 patients (92.8%). Total procedural complication rate was 8/111 (7.2%). No serious access-site complications were reported. Symptomatic ICH occurred in 18/111 (16.2%) patients. Clinical follow-up was available for 104 out of 111 total patients; of them, mRS scores of 0-2 were 54/104 (51.9%)ConclusionsThe high technical effectiveness and good safety profile of this specific tricoaxial setup for TRA-MT in AIS, even for large proximal LVOs, could constitute an optimal alternative to TFA-MT in selected cases.