Efficacy and safety of endovascular therapy for posterior cerebral artery occlusion stroke – Cohort study

Introduction

Endovascular therapy (EVT) is a highly effective stroke treatment, but trials that led to its approval did not include patients with posterior cerebral artery (PCA) occlusion. Recent studies have suggested an increased risk of intracranial haemorrhage and mortality with treatment in this population. The aim of this study was to compare efficacy and safety of EVT for PCA occlusion with that of EVT for middle cerebral artery occlusion.

Methods

Multicentric retrospective cohort study involving a consecutive sample of 2501 patients treated with EVT between January 2015 and December 2022. Efficacy outcomes of interest were recanalization, early neurological improvement and 3-month good and excellent functional outcomes. Safety outcomes of interest were intracerebral hemorrhage, intracranial hemorrhage and 3-month mortality. Logistic regression was used to adjust for confounding.

Results

PCA treated patients were more often male, had higher systolic blood pressure, lower NIHSS and more frequently had stroke of atherosclerotic and other/undetermined cause. On univariate analysis, EVT for PCA occlusion was associated with lower rates of recanalization (OR=0.38) and early neurological improvement (OR=0.60), with no differences in functional outcomes or any of the safety outcomes. After adjustment for potential confounders, EVT for PCA occlusion was associated with lower rates of recanalization (OR=0.37), good (OR=0.58) and excellent functional outcome (OR=0.60), again with no differences in terms of safety outcomes.

Conclusion

Compared to MCA occlusion, EVT for PCA occlusion appears equally safe but less effective, owing to lower recanalization rates. Randomized trials are required to definitely determine the value of this intervention for this patient population.