Abstract Background and aims Evidence for mechanical thrombectomy (MT) in isolated posterior cerebral artery occlusion (iPCAO) is limited. We compared MT versus best medical treatment (BMT) in a Spanish multicenter cohort. Methods Retrospective multicenter registry of adults with iPCAO between 2019-2025. Data on demographics, vascular risk factors, and clinical and radiological characteristics were collected. Primary outcome was good functional outcome (defined as modified Rankin Scale mRS 0–2) at 90-days. Secondary outcomes were excellent outcome (mRS 0–1) and early neurological improvement at discharge (NIHSS decrease ≥4). Safety outcomes were any intracranial hemorrhage (ICH), symptomatic ICH (sICH), and 90-day mortality. Treatment effects were estimated with propensity-score inverse probability of treatment weighting (IPTW). Results 656 patients were included from 17 stroke centers in Spain; 214 (32.6%) underwent MT. Intravenous thrombolysis use was similar in both groups (~28%). MT patients had higher baseline NIHSS (median 8 vs 4) and more P1 occlusions (58.8% vs 29.1%). Successful reperfusion (mTICI 2b–3) was achieved in 79.4% of MT cases. See table for main results. Conclusions MT is associated with early neurological recovery but showed no 90-day functional benefit after adjustment and was associated with more sICH. These results support the need for better patient selection and randomized-designed studies in iPCAO. Conflict of interest Name of author: nothing to disclose Table 1 - belongs to Results
Barberá et al. (Fri,) studied this question.