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et minimal experience standards before autonomization, and to set-up operators' recertification processes tailored to individual case volume and prior experience. Distal medium vessel occlusions (DMVOs) are increasingly considered for endovascular thrombectomy but are difficult to detect on computed tomography angiography (CTA). We aimed to determine whether time-to-maximum of tissue residue function ( ) maps, derived from CT perfusion, can be used as a triage screening tool to accurately and rapidly identify patients with DMVOs. Consecutive