Introduction Basilar tip aneurysmscan bechallenging to treatgiven their location andoftencomplex geometryand size.Endovascular coilinghas historically been the standardoftreatmentfor less complex aneurysms, proving to bebothsuccessfulandsafe.However, recanalization ratesfor large and giant aneurysmshave beenunacceptably high.More recently, devicessuch asthe Woven EndoBridge (WEB) have been developed toreduce the rate of recanalization.Here we describea uniquecase of alarge basilar tip aneurysm that was treated withcombination oftheWEBdeviceandcoilembolizationsimultaneously. Methods Case report. Results A woman in her fifties presented with several days of headache, nausea and vomiting, vision changes, and unsteady gait. MRA of the brain visualized a large unruptured basilar tip saccular aneurysm which was confirmed via a diagnostic cerebral angiogram (size: 12.9×11.2×14.0 mm, neck: 4.5 mm) [Figure 2A]. Given the sizeand locationof the aneurysm,we attempted embolization with the largest available WEBSLdevice. This device was undersized for the aneurysm.We therefore utilized a novel combinationcoiling,to partially fill the dome and posterior aneurysm sac,and the largest WEB SL available (11×9 mm). Using a radial system, the WEB device was partly unsheathed at the base of the aneurysm. Then, using a femoral system three coils (18 Hydroframe 28cm 7mm, 18 Hydroframe 15cm 7mm 10, 10 Hydroframe 23cm 7mm) were introduced into the remaining space of the aneurysm, filling the void between the aneurysm dome and the partly deployed WEB SL device. Once all coils were appropriately placed and stable, the WEB device was fully deployed, which lead to successful embolization and occlusion of the aneurysm [Figure 2B]. Conclusions The challenge of treatinglargebasilar tip aneurysmshasencouragedthedevelopment of innovative devices and novel interventional techniques.Here we demonstratethepossibility ofcombiningaWEBdevicewith standard coilingto treatlarge, wide‐necked basilar tip saccularaneurysms that are not ideal candidates for standard therapy.

Introduction Stroke is a leading cause of morbidity and mortality, and many factors predict a poor outcome, including age, NIH Stroke Scale (NIHSS), ambulatory status, and ability to swallow1. Mood disorders have previously been associated with an increased risk of cardiovascular disease2. The association between pre‐existing mood disorders and stroke outcome, however, has not been well studied. The objective of the current study was to explore the impact of pre‐existing depression on functional outcomes post‐endovascular treatment. Methods We reviewed the records of 178 patients who received mechanical thrombectomy (MT) at our institution[BH1][BM2] from 2019–2022. We collected data on baseline characteristics and demographics, including functional outcome at 90 days as measured by modified Rankin Scale (mRS), which was categorized as favorable (mRS 0–2) or unfavorable (mRS 3–6). Results Of patients who received MT, 54 (30.3%) had a prior medical history of depression. On univariate analysis, patients with a history of depression had 2.5 times higher odds of an mRS score of 3–6 (cOR = 2.47, 95% CI = 1.11‐5.48). Multivariate analysis included history of smoking, hypertension, obesity, Alberta Stroke Program Early CT Score (ASPECTS)[YC1][KC2], time to recanalization, and discharge NIHSS score, along with history of depression. We found that the odds of having an unfavorable mRS were 5 times higher in those with a history of depression than those with no history (aOR = 5.15, 95% CI = 1.09‐23.31). Additionally, discharge NIHSS was associated with 1.5 times higher odds of unfavorable mRS for each point increase in NIHSS score (aOR = 1.47, 95%CI = 1.25‐1.74). While pre‐existing depression was associated with poorer functional outcomes, it was not associated with mortality, cOR = 1.12, 95%CI = 0.55‐2.27. Conclusions In this study, we found that a prior medical history of depression is associated with unfavorable functional outcomes at 90 days in patients who received MT. Future studies should investigate the association between the severity of depression and stroke outcomes and explore methods to mitigate the impact of depression on stroke outcomes.

Introduction Obesity is a chronic disease that continues to increase in prevalence across the globe. In population studies, obesity has been shown to increase the risk for ischemic strokes. However, the obesity paradox has been observed in several studies showing better post‐stroke outcomes in patients with obesity than in those with normal weight.The influence of BMI in ischemic strokes treated with mechanical thrombectomy (MT) remains unclear. We aimed to assess if obesityis associated with poor functional outcomes defined as a modified Rankin Scale (mRS) score of 3–6 in patients following mechanical thrombectomy. Methods We reviewed 178 patients with large vessel occlusion (LVO) who underwent MT between 2019 and 2022. Obesity was defined as BMI ≥ 30.0 kg/m2.The primary outcome was mRS at 90 days. Secondary endpoints were time from puncture to reperfusion, number of passes before revascularization, the ratesof successful reperfusion using thethrombolysis in cerebral infarction(TICI)scale (mTICI≥ 2b), and mortality rate.Univariate analysis for primary and secondary endpoints was conducted using chi‐square for categorical variables and independent samples t‐tests for continuous variables. Multivariate logistic regression was used to examine the role of obesity and potential covariates on 90‐day mRS. All analyses were conducted using IBM SPSS Statistics version 27. Results Of the studied patients, 45% had obesity. Those with obesity were younger (mean age = 61.42 vs 68.25 years in those without obesity, t = 3.21, p< 0.001)), and had higher baseline glucose levels (156.3 mg/dL vs. 136.4 mg/dL, t = ‐2.06, p = 0.02). There were no significant differences in baseline NIHSS score, ASPECTS, history of congestive heart failure, hypertension, IV tPA administration, use of general anesthesia, or occlusion site. Here, obesity was not a predictor of 90‐ day mRS (aOR = 0.49, 95%CI = 0.20‐1.20). There were no significant differences in 90‐day mRS for any additional variables included in the model.For secondary endpoints, there were no significant differences in timing from puncture time to time of reperfusion (p = 0.40), number of passes before revascularization (p = 0.47), the rate of successful reperfusion (p = 0.65), and NIH score at discharge (p = 0.46). While not a focus of the current study, it is interesting to note that, compared to those with obesity, overweight patients had higher odds of mortality during the study period (cOR = 2.83, 95%CI = 1.35‐5.93). However, this relationship was only present on univariate analysis. Conclusions Obesity is highly prevalent in patients undergoing mechanical thrombectomy. In this study, we found that body mass index is not a predictor of functional outcomes in patients who undergo mechanical thrombectomy. There is no difference in intraprocedural times or likelihood of successful recanalization. Body mass index does not change the likelihood of discharge to an acute rehabilitation facility.