Background and Aims: Limited data exist on acute revascularization treatment with IV thrombolysis (IVT) and/or endovascular treatment (EVT) in stroke from isolated posterior cerebral artery occlusion (IPCAO). We aimed at investigating efficacy and safety of IVT and EVT in our single centre cohort of IPCAO. Methods: We selected all consecutive patients with IPCAO from ASTRAL registry (acute stroke admitted<24h from onset/last-seen-well) between 2003 and 6/2018. Inclusion criteria were: -proximal occlusions potentially accessible to EVT (i.e. proximal to bifurcation in parieto-occipital and calcarine arteries). -no concomitant acute occlusion of basilar artery or other intracranial arteries. We retrospectively compared 1)IVT to conservative treatment (CT) and 2)EVT to best medical therapy (BMT, i.e. CT or IVT) in term of subacute cognitive deficit, 3-months visual and disability outcomes. Unadjusted analysis, multivariable logistic regression and propensity score-matched analysis were performed. Results: Among 106 patients with IPCAO, 21 received EVT (13 bridging), 34 IVT alone and 51 CT. Median age was 76 years, 47% were female, and median NIHSS was 7. Complete recanalization at 24 hours was more often achieved with IVT than CT (51% vs. 9%, p<0.005), and with EVT compared to BMT (68% vs. 34%, p<0.05). Haemorrhagic complications and mortality didn’t increase with IVT nor EVT. Higher proportions of good cognitive, visual and disability outcomes were observed in IVT vs. CT and in EVT vs. BMT (see Table).
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