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Updated: Dec 13, 2025
Optimized Management of Endovascular Treatment for Acute Ischemic Stroke
Published on: January 18, 2018
Mechanical thrombectomy in isolated large vessel posterior cerebral artery occlusions
Muhammad Zeeshan Memon1, Marina Kushnirsky2, Marie Christine Brunet2
1Departments of Neurology and Neurosurgery, Jackson Memorial Hospital, University of Miami Miller School of Medicine Miami, FL, Miami, USA. zeeshanmemon@gmail.com.
Purpose:
Mechanical thrombectomy (MT) in posterior circulation large vessel occlusion (LVO), including posterior cerebral artery (PCA), has not been validated since all five major MT trials excluded such patients. To evaluate the feasibility and preliminary safety and efficacy of MT in isolated PCA occlusion stroke patients with new-generation MT devices.
Methods:
Endovascularly treated acute ischemic stroke (AIS) patients were identified from a prospectively collected database and their baseline characteristics were noted. Clinical outcomes were angiographic recanalization, a favorable clinical outcome at 3 months on modified Rankin Scale (mRS) and visual field (VF) deficit improvement on confrontation test, rate of intracranial hemorrhage (ICH), and mortality at 3 months.
Results:
A total of 355 AIS patients underwent MT from January 2018 to December 2019. Isolated PCA MT was performed in 15 consecutive patients. The mean age was 64 ± 17 years, and 9(60%) were women. Median presentation NIHSS was 9 (interquartile range 5-15). MT devices used were stent retrievers in 6 patients and combined aspiration and stent retriever in 9 patients. Complete revascularization (TICI 2c or 3) was achieved in 12/15 patients. 3-month VF normalization was seen in 7/12 of the patients. Post-procedure symptomatic ICH occurred in 1/15 of patients. mRS score of 0-2 was achieved in 9/15 of patients but one patient was dead at 3 months post procedure.
Conclusion:
MT is feasible and can achieve successful reperfusion in isolated PCA occlusions and resulted in favorable motor and visual outcomes in this small series of ischemic stroke patients.
Insights
Mechanical thrombectomy (MT) is feasible for posterior circulation stroke, specifically isolated posterior cerebral artery (PCA) occlusions. This study shows successful reperfusion and favorable outcomes in PCA occlusion patients treated with MT.
Area of Science:
- Neurology
- Interventional Neurology
- Stroke Medicine
Background:
- Mechanical thrombectomy (MT) trials have largely excluded posterior circulation large vessel occlusions (LVO), including posterior cerebral artery (PCA) occlusions.
- The efficacy and safety of MT for isolated PCA occlusions remain under-evaluated.
Purpose of the Study:
- To assess the feasibility, safety, and efficacy of MT in patients with acute ischemic stroke due to isolated PCA occlusion.
- To evaluate outcomes using new-generation MT devices in this specific patient cohort.
Main Methods:
- Retrospective analysis of prospectively collected data from acute ischemic stroke (AIS) patients undergoing MT.
- Included 15 consecutive patients with isolated PCA occlusions treated between January 2018 and December 2019.
- Assessed outcomes including angiographic recanalization, modified Rankin Scale (mRS) at 3 months, visual field (VF) deficit improvement, intracranial hemorrhage (ICH), and mortality.
Main Results:
- Successful reperfusion (TICI 2c or 3) was achieved in 12 out of 15 patients.
- Visual field normalization occurred in 7 out of 12 patients at 3 months.
- Favorable functional outcome (mRS 0-2) was achieved in 9 out of 15 patients, with one 3-month mortality.
Conclusions:
- Mechanical thrombectomy is a feasible reperfusion strategy for isolated posterior cerebral artery occlusions.
- MT demonstrates potential for favorable motor and visual outcomes in this stroke subtype.
- Further research is warranted given the small sample size.
