Abstract Background and aims The optimal reperfusion technique in patients with isolated posterior cerebral artery (PCA) occlusion remains uncertain. We aimed to compare technical and clinical outcomes according to first-line endovascular therapy (EVT) technique. Methods Retrospective, single-center study including isolated PCA occlusion treated with EVT within 24 hours of time last seen well between January/2020-June/2025. First-line EVT technique was categorized: contact aspiration (CA), stent retriever (SR) or combined technique. The primary outcome was first-pass effect (FPE), defined as TICI 2c/3 after the first pass. Secondary outcomes included successful reperfusion, complications and functional outcome at 90 days. Results Forty-five patients were included (median age 77 years; median NIHSS 7). P1 occlusion was the most frequent (48.9%). First-line EVT was combined in 38.5%, CA in 35.9%, and SR in 25.6%. First-pass effect was achieved in 51.3%, with no significant differences between techniques. Final successful reperfusion was achieved in 82.1% of patients. The median number of passes was 1 and procedural complications occurred in 11.4%. A ≥2-point NIHSS reduction at discharge was observed in 74.4% of patients. At 90 days, functional independence (mRS 0–2) was achieved in 35.1%. Rates of symptomatic intracranial hemorrhage (10.3%) and 90-day mortality (12.8%) were comparable among techniques. Conclusions In this single-center, EVT achieved high rates of reperfusion with acceptable safety profiles. No first-line EVT technique demonstrated superiority in technical or clinical outcomes. Larger multicenter studies are needed to define the optimal EVT strategy. Conflict of interest Stefanie Moreira: nothing to disclose
Moreira et al. (Fri,) studied this question.