Title: Efficacy And Safety Of Endovascular Treatment Versus Best Medical Management For Isolated Posterior Cerebral Artery Occlusion: A Systematic Review And Meta-analysis
Authors: Muhammad Hassan Waseem, Zain ul Abideen, Sania Aimen, Justin Chen, Jamir Pitton Rissardo, Brandon Lucke-Wold
Conference: 2025 CNS Annual Meeting, Los Angeles, CA
Introduction
Many key Randomized clinical trials (RCTs) for Endovascular thrombectomy (EVT) in ischemic stroke included limited cases of isolated posterior cerebral artery occlusions (iPCAO), making the benefits of EVT in this population unclear.
Objective
This study aims to analyze the efficacy and safety of EVT in iPCAO.
Methods
PubMed, ScienceDirect, and the Cochrane Library were searched from inception till October 2024. Risk Ratios (RR) with 95 % CI were pooled under the random effects model using Review Manager 5.4.1 for the dichotomous outcomes. The primary outcome was an early neurological improvement (NIHSS ≥2). The secondary endpoints were visual field normalization, favourable functional outcome (mRS 0-2) at 3 months, excellent functional outcomes (mRS 0-1) at 3 months, symptomatic intracranial hemorrhage (sICH), and mortality. Quality assessment was done through the Newcastle Ottawa Scale. To investigate the heterogeneity a sensitivity analysis was performed. Publication bias was assessed visually through the funnel plots and statistically through Egger’s regression test.
Results
Ten studies encompassing 38,655 patients were included in this meta-analysis. EVT significantly increased the early neurological improvement compared to best medical management (BMM) (RR= 1.42; 95%CI: [1.32,1.54]; p<0.00001; I2= 0%). EVT also significantly increased the risk of sICH in iPCAO with an RR of 2 (95%CI: [1.07,3.71]; p=0.03; I2=46%). Other outcomes including favourable functional outcome (mRS 0-2) at 3 months (RR=0.92; 95%CI: [0.84,1.00]; p=0.05; I2=51%), visual field normalization (RR=1.44; 95%CI:[0.96,2.15]; p=0.08; I2=68%), excellent functional outcome (mRS 0-1) at 3 months (RR=1.05; 95%CI:[0.95,1.15]; p=0.36; I2=0%) and mortality at 3 months (RR=1.38; 95%CI:[0.88,2.17]; p=0.16; I2=51%) were comparable between the EVT and BMM.
Conclusions
EVT significantly improves early neurological outcomes in patients with isolated posterior cerebral artery occlusions compared to best medical management, though it also increases the risk of sICH. Other outcomes, including functional recovery and mortality, were similar between EVT and medical management.
Citation
Waseem MH, Abideen Z, Aimen S, Chen J, Pitton Rissardo J, Lucke-Wold B. Efficacy And Safety Of Endovascular Treatment Versus Best Medical Management For Isolated Posterior Cerebral Artery Occlusion: A Systematic Review And Meta-analysis. CNS Annual Meeting 2025;2025:1094. https://www.cns.org/poster-search?id=1094
Figure. Risk ratio of EVT vs BMT for early neurological improvement, visual field normalization, and favourable functional outcome across studies.
Figure. Risk ratio of EVT vs BMT for excellent functional outcome, symptomatic intracranial hemorrhage, and mortality across studies.