Clinical outcomes of intra-arterial thrombectomy versus medical therapy for isolated posterior cerebral artery occlusion

Background: With the demonstrated efficacy of intra-arterial thrombectomy (IAT) in patients with acute large vessel occlusion, its use has expanded to medium vessel occlusions. However, most studies have primarily focused on anterior circulation ischemic stroke. Therefore, we aimed to investigate the effects of early IAT, performed within the golden hour, in patients with isolated posterior cerebral artery (PCA) occlusion-related ischemic stroke. Methods: This retrospective study included 102 patients with isolated PCA occlusion who presented to a local tertiary medical center. The patients were categorized into two groups based on their IAT history, presence of visual symptoms, and modified Rankin Scale (mRS) scores. Results: Patients who underwent IAT had higher National Institutes of Health Stroke Scale (NIHSS) scores at admission (P<0.001). Although the mRS scores differed between the two groups at admission (P=0.002), no significant differences were observed between the groups at 3 (P=0.205) and 12 months (P=0.165). Patients with visual symptoms were younger (P=0.023) and had lower NIHSS scores on admission (P=0.002). Among patients with isolated PCA P1 occlusion stroke, higher serum albumin levels and lower NIHSS scores were associated with good outcomes (mRS score, 0–2) at 3 months (P<0.001). Conclusions: Patients with isolated PCA occlusion, higher serum albumin levels, and lower NIHSS scores at admission had favorable outcomes, underscoring the potential prognostic value of patients’ nutritional status at admission. Relatively high NIHSS scores at admission, even during IAT, resulted in minimal procedure-related complications and a minimal difference in outcomes over time. Therefore, prompt IAT should be considered for patients with isolated PCA occlusion and severe symptoms at admission.