ABSTRACT NUMBER: ESOC2026A670 PERFUSION IMAGING AND CLINICAL OUTCOME IN ACUTE STROKE WITH POSTERIOR CEREBRAL ARTERY OCCLUSION

Abstract Background and aims Endovascular therapy (EVT) is not recommended for acute stroke due to posterior cerebral artery (PCA) occlusion. Perfusion imaging may identify patients who could benefit from EVT. Methods We conducted a multicenter international observational study of consecutive acute stroke patients with isolated PCA occlusion (P1/P2), admitted ≤ 6 hours from symptom onset and with baseline perfusion imaging. Patients received best medical management (BMM) alone or combined with EVT. The primary outcome was good functional outcome (GFO), defined as 3-month modified Rankin Scale score 0–2 or return to baseline mRS. Propensity-score with overlap weighting (PSOW) was used to balance baseline characteristics. Interaction between treatment strategy and perfusion mismatch volume was tested. Results Overall, 295 patients were included (69 BMM + EVT, 226 BMM alone). Median age was 74 years (IQR 64-83), median NIHSS was 6 (3-10), occlusion site was P1 in 21% and P2 in 79%, intravenous thrombolysis used in 70%. Median core volume was 1.5 mL (0-8) and mismatch volume was 15 mL (4-32). The distribution of baseline variables was similar across the 2 groups following PSOW. EVT was not associated with GFO (PSOW-OR 0.99, 95%CI 0.54–1.83; P = 0.97). The association between EVT and GFO was not modified by mismatch volume (Pinteraction = 0.42). Similar results were observed for mRS 0-1. Conclusions In this cohort of acute strokes with PCA occlusion, EVT was not associated with GFO compared to BMM alone. Perfusion mismatch volume did not modify this association and may not be useful to select good EVT candidates in this patient group. Conflict of interest Sabben: Nothing to disclose/Turc reports lecture fees from Guerbert France and consultant services for AI-Stroke and Neurologica/Obadia: Nothing to disclose/Charbonneau: Nothing to disclose/Strambo: Nothing to disclose/Heldner reports grants from SITEM Research Support Funds and Swiss National Science Foundation, Swiss Heart Foundation/Ong: Nothing to disclose/Ter Schiphorst: Nothing to disclose/Sibon: Nothing to disclose/Legris: Nothing to disclose/Carrera: Nothing to disclose/Mione: Nothing to disclose/Bagan-Triquenot: Nothing to disclose/Mazighi reports consulting fees from Acticor Biotech, Boerhinger/Seners speaker fees from Acticor Biotech and Boerhinger-Ingelheim.