Endovascular therapy versus best medical management for isolated posterior cerebral artery occlusion: A systematic review and meta-analysis

Abstract

Background and purpose: Isolated posterior cerebral artery occlusions (iPCAO) were underrepresented in pivotal randomized clinical trial (RCTs) of endovascular thrombectomy (EVT) in ischemic stroke, and the benefit of EVT in this population is still indeterminate. We performed a systematic review and a meta-analysis to compare the safety and efficacy of EVT compared to best medical management (BMM) in patients with iPCAO. Methods: We searched Medline/PubMed, Embase, Web of Science, and the Cochrane databases up to May 2023 for eligible studies reporting outcomes of patients with iPCAO treated with EVT or BMM. We pooled odds ratios (ORs) with corresponding 95% confidence intervals (CI) using a random-effects model. Results: Seven studies involving 2560 patients were included. EVT was associated with significantly higher likelihood of early neurological improvement (OR, 2.31 [95% CI, 1.38–2.91]; p < 0.00001) and visual field normalization (OR, 3.08 [95% CI, 1.76–5.38]; p < 0.0001) compared to BMM. Rates of good functional outcomes (mRS 0–2) were comparable between the two arms (OR, 0.88 [95% CI, 0.70–1.10]; p = 0.26). Symptomatic intracranial hemorrhage (sICH) was comparable between the two groups (OR, 1.94 [95% CI, 0.96–3.93]; p = 0.07). Mortality was also similar between the two groups (OR, 1.36; [95% CI, 0.77–2.42]; p = 0.29). Conclusions: In patients with iPCAO, EVT was associated with visual and early neurological improvement but with a strong trend toward increased sICH. Survival and functional outcomes may be slightly poorer. The role of EVT in iPCAO remains uncertain.