ABSTRACT NUMBER: ESOC2026A2397 FIRST-LINE ENDOVASCULAR THERAPY TECHNIQUE IN ISOLATED POSTERIOR CEREBRAL ARTERY OCCLUSION: A PORTUGUESE TERTIARY CENTER EXPERIENCE

Abstract Background and aims The optimal reperfusion technique in patients with isolated posterior cerebral artery (PCA) occlusion remains uncertain. We aimed to compare technical and clinical outcomes according to first-line endovascular therapy (EVT) technique. Methods Retrospective, single-center study including isolated PCA occlusion treated with EVT within 24 hours of time last seen well between January/2020-June/2025. First-line EVT technique was categorized: contact aspiration (CA), stent retriever (SR) or combined technique. The primary outcome was first-pass effect (FPE), defined as TICI 2c/3 after the first pass. Secondary outcomes included successful reperfusion, complications and functional outcome at 90 days. Results Forty-five patients were included (median age 77 years; median NIHSS 7). P1 occlusion was the most frequent (48.9%). First-line EVT was combined in 38.5%, CA in 35.9%, and SR in 25.6%. First-pass effect was achieved in 51.3%, with no significant differences between techniques. Final successful reperfusion was achieved in 82.1% of patients. The median number of passes was 1 and procedural complications occurred in 11.4%. A ≥2-point NIHSS reduction at discharge was observed in 74.4% of patients. At 90 days, functional independence (mRS 0–2) was achieved in 35.1%. Rates of symptomatic intracranial hemorrhage (10.3%) and 90-day mortality (12.8%) were comparable among techniques. Conclusions In this single-center, EVT achieved high rates of reperfusion with acceptable safety profiles. No first-line EVT technique demonstrated superiority in technical or clinical outcomes. Larger multicenter studies are needed to define the optimal EVT strategy. Conflict of interest Stefanie Moreira: nothing to disclose