BACKGROUND AND PURPOSE: The purpose of this study was to evaluate the safety and effectiveness of mechanical thrombectomy (MT) in patients with acute ischaemic stroke related to isolated and primary posterior cerebral artery (PCA) occlusions amongst the patients enrolled in the multicentre post-market Trevo Registry. METHOD: Amongst the 2008 patients enrolled in the Trevo Registry with acute ischaemic stroke due to large vessel occlusion treated by MT, 22 patients (1.1%) [10 females (45.5%), mean age 66.2 ± 14.3 years (range 28-91)] had a PCA occlusion [17 P1 (77.3%) and five P2 occlusions (22.7%)]. Recanalization after the first Trevo (Stryker, Fremont, CA, USA) pass and at the end of the procedure was rated using the modified Thrombolysis in Cerebral Infarction (mTICI) score. Procedure-related complications (i.e. groin puncture complication, perforation, symptomatic haemorrhage, embolus in a new territory) were also recorded. The modified Rankin Scale at 90 days was assessed. RESULTS: Median National Institutes of Health Stroke Scale at admission was 14 (interquartile range 8-16). Stroke aetiology was cardio-embolic in 68.2% of cases. Half of the patients (11/22) received intravenous tissue plasminogen activator. 54.5% of the patients were treated under general anaesthesia. Reperfusion (i.e. mTICI 2b or 3) after first pass was obtained in 65% of cases. Final mTICI 2b-3 reperfusion was obtained in all cases. Only one (4.5%) procedure-related complication was recorded (puncture site) that resolved after surgery. At 90-day follow-up, modified Rankin Scale 0-2 was obtained in 59% of the patients and 9.1% died within the first 3 months after MT. CONCLUSION: Mechanical thrombectomy for PCA occlusions seems to be safe (<5% procedure-related complications) and effective. Larger repository datasets are needed.

Department of Anesthesiology Pitié Salpêtrière Hospital Paris France

Department of Neurology and Comprehensive Stroke Center David Geffen School of Medicine University of California Los Angeles CA USA

Department of Neurology Marcus Stroke and Neuroscience Center Grady Memorial Hospital Emory University Atlanta GA USA

Department of Neuroradiology Pitié Salpêtrière Hospital Paris France

Department of Radiology Interventional Neuroradiology Unit Lausanne University Hospital Lausanne Switzerland

Department of Radiology University Hospital Hradec Kralove Hradec Kralove Czech Republic

Department of Vascular Neurology Pitié Salpêtrière Hospital Paris France

Department of Vascular Neurology Saint Antoine University Hospital Paris France

Endovascular Neurosurgery Drexel Neurosciences Institute Philadelphia PA USA

Hospital de Donostia San Sebastian España

Hospital Universitario Son Espases Mallorca España

Interventional Neurology California Pacific Medical Center San Francisco CA USA

Interventional Neurology Wellstar Health System Atlanta GA USA

Interventional Neuroradiology Erlanger Chattanooga TN USA

Interventional Neuroradiology Riverside Methodist Hospital Ohio Health Research Institute Columbus OH USA

Sorbonne University Paris France

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