Endovascular thrombectomy for isolated posterior cerebral artery occlusion: distinct clinical presentation patterns and neurological outcomes in P1 versus P2 segments

Background: Endovascular thrombectomy (EVT) for isolated posterior cerebral artery (PCA) occlusion remains incompletely characterized, particularly regarding segment-specific presentation and outcomes. We aimed to compare clinical profiles, procedural results, and early neurological and imaging outcomes between P1 and P2 PCA occlusions treated with EVT. Methods: = 12). Successful reperfusion was defined as mTICI 2b-3. Baseline and 24-h CT were assessed for detecting ischemic change using posterior circulation ASPECTS (PC-ASPECTS). Neurological deficits were analyzed using NIHSS total scores and clinical domain profiles. Results: Patients with P1 occlusion presented with higher admission stroke severity than those with P2 occlusion [NIHSS 12 (7-23) vs. 7 (4-9)] and more frequent motor/sensory deficits and facial palsy, whereas P2 occlusions commonly presented with visual dysfunction. Successful reperfusion was achieved in 72% overall (P1 78% vs. P2 58%). Median 24-h PC-ASPECTS was similar [8 (IQR 8-9)]. Despite successful reperfusion in P1 occlusion, neurological impairment frequently persisted at discharge, particularly in motor, sensory, vigilance, and language-related domains. Infarct demarcation at 24 h remained frequent, including thalamic involvement in 41% (P1) and 36% (P2). For P1 occlusions, successful reperfusion was associated with less thalamic (29% vs. 83%) and occipital (52% vs. 83%) infarct demarcation. Any intracranial hemorrhage occurred in 13% without segment differences; in-hospital mortality was 26%. Conclusion: P1 and P2 segment occlusions showed distinct clinical phenotypes, while EVT was technically feasible with acceptable safety. However, persistent deficits and brain tissue injury were common despite successful reperfusion.