Endovascular versus medical management of posterior cerebral artery occlusion stroke

Endovascular treatment (EVT) of posterior cerebral artery (PCA) strokes is uncertain. We present our single-center experience with acute ischemic strokes (AIS) caused by PCA occlusion.

This study included consecutive patients with PCA occlusion presenting within 24 hours of time last well-known from January 2017 to June 2024. Patients treated with EVT, or medical management (MM) were compared with multivariable logistic regression and inverse probability of treatment weighting. The primary outcome was the 90-day modified Rankin Scale (mRS) score. The safety outcomes were symptomatic intracranial hemorrhage (sICH) and mortality.

Overall, 53 patients were treated with MM and 16 with EVT. The 90-day mRS score of 0-2 was seen in 43.8 % of the EVT and 67.3 % in the MM group (p = 0.90). There was a higher rate of early decrease in NIHSS score ≥ 2 points was observed in the EVT group, but this was not statistically significant. Vision recovery was similar between groups. One patient had symptomatic ICH, and one patient underwent decompression due to edema. The proportion of patients with non-symptomatic ICH was higher in the EVT group (p = 0.025). Admission NIHSS > 6 was significantly associated with poor prognosis and mortality(p < 0.001).

Our results show no difference in functional outcome at 90 day between EVT and MM groups. We could not demonstrate a significant difference in sICH and mortality. EVT can be safe in PCA occlusion especially with admission NIHSS > 6.