ABSTRACT NUMBER: ESOC2026A2089 MECHANICAL THROMBECTOMY FOR ISOLATED POSTERIOR CEREBRAL ARTERY OCCLUSION IN REAL CLINICAL PRACTICE

Abstract Background and aims Mechanical thrombectomy is the standard treatment for stroke for large vessel occlusion. However, the indication for isolated posterior cerebral artery occlusion (PCA) is still unclear. Methods All consecutive patients from two centers who underwent mechanical thrombectomy of PCA occlusion were included in the retrospective analysis. Patients were routinely given intravenous thrombolysis and an attempt at aspiration mechanical thrombectomy was performed as part of endovascular intervention. The safety of the treatment was assessed according to the presence of intracerebral complications of the procedure and the occurrence of symptomatic intracerebral hemorrhage on follow-up CT. Results 72 mechanical thromboctomies (age 73.5±1, 54% male) were performed for isolated posterior cerebral artery occlusion. The P1 segment PCA was present in 53 cases (74%) and the P2 segment in 19 cases (26%).The procedure was successful (TICI≥2b) in 51 patients (71%). A good clinical outcome (mRS≤2) was achieved in 35 patients (49%). Intracranial arterial perforation occurred three times (4%) and significant embolization to another intracranial artery twice (3%). Intracerebral hemorrhage occurred in 11 patients (15%), of which symptomatic hemorrhage in 6 patients (8%). Mortality was 26%. Conclusions Mechanical thrombectomy for isolated posterior cerebral artery occlusion is a feared endovascular challenge due to the risk of arterial perforation with fatal outcome. This concern is reflected in some cases in the lower intensity of the endovascular procedure (termination of the procedure after an unsuccessful first passage) with a subsequent lower rate of successful recanalization. However, 49% of patients achieved self-healing. Mechanical thrombectomy should also be considered in this location of occlusion. Conflict of interest Cernik David: nothing to disclose, Fedorko Jakub: nothing to disclose, Soltezova Klaudia: nothing to disclose, Gdovinova Zuzana: nothing to disclose, Viglas Pavol: nothing to disclose, Cihlar Filip: nothing to disclose