ABSTRACT NUMBER: ESOC2026A2339 EXPERIENCE FROM A PORTUGUESE TERTIARY HOSPITAL IN ISOLATED POSTERIOR CEREBRAL ARTERY OCCLUSION: MEDICAL MANAGEMENT OR ENDOVASCULAR THERAPY

Abstract Background and aims Management of acute ischemic stroke due to posterior cerebral artery (PCA) occlusion remains uncertain, particularly regarding the role of endovascular therapy (EVT). We aimed to compare clinical and functional outcomes between patients treated with medical management (MM) or EVT and to assess complications. Methods Retrospective, single-center-study including isolated PCA occlusion admitted within 24hours of time last seen well between January/2020-June/2025. Early neurological improvement was defined as a ≥2-point reduction in NIHSS at discharge. Functional outcome was assessed by the mRS at 90-days. Intracranial hemorrhage and 90-day mortality were recorded. Univariate and multivariate logistic regression analyses were performed. Results Sixty-seven patients were included: 45 EVT, 22 MM. EVT patients were older (77 vs. 63 years; p=0.007) and had higher baseline NIHSS scores (7 vs. 3; p<0.001). P1 segment occlusions were more frequent in the EVT group, while thrombolysis rates were similar. A ≥2-point NIHSS reduction at discharge occurred more frequently in EVT (68.9% vs. 36.4%, p=0.017). At 90 days, EVT patients had higher median mRS scores and fewer achieved functional independence (mRS 0–2: 37.8% vs. 72.7%, p=0.018). This associations were not maintained after adjustment for baseline differences. Intracranial hemorrhage occurred in 15.6% of EVT (0% MM), while 90-day mortality was 4.5% in MM and 13.3% in EVT. Conclusions EVT was associated with a more pronounced early neurological improvement, but greater functional dependence at 90 days. Complications were more frequent in the EVT group. Larger, prospective multicenter studies are needed to optimize patient selection. Conflict of interest Stefanie Moreira: nothing to disclose