{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,4,21]],"date-time":"2026-04-21T15:35:40Z","timestamp":1776785740628,"version":"3.51.2"},"reference-count":33,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2026,4,21]],"date-time":"2026-04-21T00:00:00Z","timestamp":1776729600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Neurol."],"abstract":"<jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Endovascular thrombectomy (EVT) for isolated posterior cerebral artery (PCA) occlusion remains incompletely characterized, particularly regarding segment-specific presentation and outcomes. We aimed to compare clinical profiles, procedural results, and early neurological and imaging outcomes between P1 and P2 PCA occlusions treated with EVT.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>\n                      We retrospectively analyzed EVT-treated patients with acute ischemic stroke at a tertiary center from 2018\u20132025 (\n                      <jats:italic>n<\/jats:italic>\n                      \u202f=\u202f1,166). Thirty-nine patients with isolated PCA occlusion were included in the final analysis (P1\n                      <jats:italic>n<\/jats:italic>\n                      \u202f=\u202f27; P2\n                      <jats:italic>n<\/jats:italic>\n                      \u202f=\u202f12). Successful reperfusion was defined as mTICI 2b\u20133. Baseline and 24-h CT were assessed for detecting ischemic change using posterior circulation ASPECTS (PC-ASPECTS). Neurological deficits were analyzed using NIHSS total scores and clinical domain profiles.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Patients with P1 occlusion presented with higher admission stroke severity than those with P2 occlusion [NIHSS 12 (7\u201323) vs. 7 (4\u20139)] and more frequent motor\/sensory deficits and facial palsy, whereas P2 occlusions commonly presented with visual dysfunction. Successful reperfusion was achieved in 72% overall (P1 78% vs. P2 58%). Median 24-h PC-ASPECTS was similar [8 (IQR 8\u20139)]. Despite successful reperfusion in P1 occlusion, neurological impairment frequently persisted at discharge, particularly in motor, sensory, vigilance, and language-related domains. Infarct demarcation at 24\u202fh remained frequent, including thalamic involvement in 41% (P1) and 36% (P2). For P1 occlusions, successful reperfusion was associated with less thalamic (29% vs. 83%) and occipital (52% vs. 83%) infarct demarcation. Any intracranial hemorrhage occurred in 13% without segment differences; in-hospital mortality was 26%.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>P1 and P2 segment occlusions showed distinct clinical phenotypes, while EVT was technically feasible with acceptable safety. However, persistent deficits and brain tissue injury were common despite successful reperfusion.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.3389\/fneur.2026.1807618","type":"journal-article","created":{"date-parts":[[2026,4,21]],"date-time":"2026-04-21T14:35:31Z","timestamp":1776782131000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":0,"title":["Endovascular thrombectomy for isolated posterior cerebral artery occlusion: distinct clinical presentation patterns and neurological outcomes in P1 versus P2 segments"],"prefix":"10.3389","volume":"17","author":[{"given":"Natalie","family":"van Landeghem","sequence":"first","affiliation":[{"name":"Institute of Diagnostic and Interventional Radiology and Neuroradiology, University Hospital Essen","place":["Essen, Germany"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Daniel","family":"van Landeghem","sequence":"additional","affiliation":[{"name":"Institute of Diagnostic and Interventional Radiology and Neuroradiology, University Hospital Essen","place":["Essen, Germany"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jordi K\u00fchne","family":"Escol\u00e0","sequence":"additional","affiliation":[{"name":"Department of Neurology and Center for Translational Neuro- and Behavioral Sciences (C-TNBS), University Hospital Essen","place":["Essen, Germany"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Benedikt","family":"Frank","sequence":"additional","affiliation":[{"name":"Department of Neurology and Center for Translational Neuro- and Behavioral Sciences (C-TNBS), University Hospital Essen","place":["Essen, Germany"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Martin","family":"K\u00f6hrmann","sequence":"additional","affiliation":[{"name":"Department of Neurology and Center for Translational Neuro- and Behavioral Sciences (C-TNBS), University Hospital Essen","place":["Essen, Germany"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Christoph","family":"Ziegenfu\u00df","sequence":"additional","affiliation":[{"name":"Institute of Diagnostic and Interventional Radiology and Neuroradiology, University Hospital Essen","place":["Essen, Germany"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Johannes","family":"Harmes","sequence":"additional","affiliation":[{"name":"Institute of Diagnostic and Interventional Radiology and Neuroradiology, University Hospital Essen","place":["Essen, Germany"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Johannes","family":"Haubold","sequence":"additional","affiliation":[{"name":"Institute of Diagnostic and Interventional Radiology and Neuroradiology, University Hospital Essen","place":["Essen, Germany"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Isabel","family":"Wanke","sequence":"additional","affiliation":[{"name":"Institute of Diagnostic and Interventional Radiology and Neuroradiology, University Hospital Essen","place":["Essen, Germany"]},{"name":"Department of Neuroradiology, Hirslanden Clinic","place":["Zurich, Switzerland"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Cornelius","family":"Deuschl","sequence":"additional","affiliation":[{"name":"Institute of Diagnostic and Interventional Radiology and Neuroradiology, University Hospital Essen","place":["Essen, Germany"]},{"name":"Institute of Diagnostic and Interventional Radiology, Neuroradiology and Nuclear Medicine, University Hospital Knappschaftskrankenhaus Bochum, Ruhr University Bochum","place":["Bochum, Germany"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Michael","family":"Forsting","sequence":"additional","affiliation":[{"name":"Institute of Diagnostic and Interventional Radiology and Neuroradiology, University Hospital Essen","place":["Essen, Germany"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Yan","family":"Li","sequence":"additional","affiliation":[{"name":"Institute of Diagnostic and Interventional Radiology and Neuroradiology, University Hospital Essen","place":["Essen, Germany"]}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1965","published-online":{"date-parts":[[2026,4,21]]},"reference":[{"key":"ref1","doi-asserted-by":"publisher","first-page":"1074","DOI":"10.1111\/j.1468-1331.2011.03384.x","article-title":"Long-term outcome in posterior cerebral artery stroke","volume":"18","author":"Ntaios","year":"2011","journal-title":"Eur J Neurol"},{"key":"ref2","doi-asserted-by":"publisher","first-page":"2122","DOI":"10.1161\/STROKEAHA.120.029949","article-title":"Incidence of acute ischemic stroke with visible arterial occlusion","volume":"51","author":"Duloquin","year":"2020","journal-title":"Stroke"},{"key":"ref3","doi-asserted-by":"publisher","first-page":"938","DOI":"10.1001\/archneur.62.6.938","article-title":"Posterior cerebral artery infarction from middle cerebral artery infarction","volume":"62","author":"Maulaz","year":"2005","journal-title":"Arch Neurol"},{"key":"ref4","doi-asserted-by":"publisher","first-page":"668","DOI":"10.1161\/STROKEAHA.115.010613","article-title":"Missed ischemic stroke diagnosis in the emergency department by emergency medicine and neurology services","volume":"47","author":"Arch","year":"2016","journal-title":"Stroke"},{"key":"ref5","doi-asserted-by":"publisher","first-page":"1273","DOI":"10.1111\/acem.13830","article-title":"Avoiding misdiagnosis in patients with posterior circulation ischemia: a narrative review","volume":"26","author":"Gurley","year":"2019","journal-title":"Acad Emerg Med"},{"key":"ref6","doi-asserted-by":"publisher","first-page":"1247","DOI":"10.1161\/STROKEAHA.120.034019","article-title":"Posterior National Institutes of Health stroke scale improves prognostic accuracy in posterior circulation stroke","volume":"53","author":"Alemseged","year":"2022","journal-title":"Stroke"},{"key":"ref7","doi-asserted-by":"publisher","first-page":"1708","DOI":"10.1161\/STROKEAHA.123.042674","article-title":"Endovascular versus medical management of posterior cerebral artery occlusion stroke: the PLATO study","volume":"54","author":"Nguyen","year":"2023","journal-title":"Stroke"},{"key":"ref8","doi-asserted-by":"publisher","first-page":"434","DOI":"10.1001\/jamaneurol.2021.0001","article-title":"Thrombectomy for primary distal posterior cerebral artery occlusion stroke: the TOPMOST study","volume":"78","author":"Meyer","year":"2021","journal-title":"JAMA Neurol"},{"key":"ref9","doi-asserted-by":"publisher","first-page":"534","DOI":"10.3171\/jns.1978.48.4.0534","article-title":"Microsurgical anatomy of the posterior cerebral artery","volume":"48","author":"Zeal","year":"1978","journal-title":"J Neurosurg"},{"key":"ref10","doi-asserted-by":"publisher","first-page":"2485","DOI":"10.1161\/strokeaha.107.511162","article-title":"Extent of hypoattenuation on CT angiography source images predicts functional outcome in patients with basilar artery occlusion","volume":"39","author":"Puetz","year":"2008","journal-title":"Stroke"},{"key":"ref11","doi-asserted-by":"publisher","first-page":"499","DOI":"10.1007\/s00062-020-00974-3","article-title":"Automated perfusion calculations vs. visual scoring of collaterals and CBV-ASPECTS","volume":"31","author":"Psychogios","year":"2021","journal-title":"Clin Neuroradiol"},{"key":"ref12","doi-asserted-by":"publisher","first-page":"232","DOI":"10.1017\/s0317167100036337","article-title":"The posterior cerebral artery syndrome","volume":"13","author":"Fisher","year":"1986","journal-title":"Can J Neurol Sci"},{"key":"ref13","doi-asserted-by":"publisher","first-page":"824","DOI":"10.1001\/archneur.56.7.824","article-title":"Posterior cerebral artery territory infarcts in the New England medical center posterior circulation registry","volume":"56","author":"Yamamoto","year":"1999","journal-title":"Arch Neurol"},{"key":"ref14","doi-asserted-by":"publisher","first-page":"170","DOI":"10.1159\/000016053","article-title":"Posterior cerebral artery territory infarcts: clinical features, infarct topography, causes and outcome: multicenter results and a review of the literature","volume":"10","author":"Brandt","year":"2000","journal-title":"Cerebrovasc Dis"},{"key":"ref15","doi-asserted-by":"publisher","first-page":"329","DOI":"10.1186\/1756-0500-4-329","article-title":"Infarctions in the vascular territory of the posterior cerebral artery: clinical features in 232 patients","volume":"4","author":"Arboix","year":"2011","journal-title":"BMC Res Notes"},{"key":"ref16","doi-asserted-by":"publisher","first-page":"714","DOI":"10.1177\/17474930211046758","article-title":"Patterns of ischemic posterior circulation strokes: a clinical, anatomical, and radiological review","volume":"17","author":"Salerno","year":"2022","journal-title":"Int J Stroke"},{"key":"ref17","doi-asserted-by":"publisher","first-page":"2472","DOI":"10.1161\/STROKEAHA.123.044240","article-title":"No-reflow post-recanalization in acute ischemic stroke: mechanisms, measurements, and molecular markers","volume":"54","author":"Sperring","year":"2023","journal-title":"Stroke"},{"key":"ref18","doi-asserted-by":"publisher","first-page":"553","DOI":"10.1136\/neurintsurg-2015-011758","article-title":"Early arrival at the emergency department is associated with better collaterals, smaller established infarcts and better clinical outcomes with endovascular stroke therapy: SWIFT study","volume":"8","author":"Liebeskind","year":"2016","journal-title":"J Neurointerv Surg"},{"key":"ref19","doi-asserted-by":"publisher","first-page":"425","DOI":"10.1007\/s00062-018-0679-z","article-title":"Posterior circulation occlusions may be associated with distal emboli during thrombectomy: factors for distal embolization and a review of the literature","volume":"29","author":"Yeo","year":"2019","journal-title":"Clin Neuroradiol"},{"key":"ref20","doi-asserted-by":"publisher","first-page":"69","DOI":"10.1177\/23969873231201715","article-title":"Endovascular therapy versus best medical management for isolated posterior cerebral artery occlusion: a systematic review and meta-analysis","volume":"9","author":"Alkhiri","year":"2024","journal-title":"Eur Stroke J"},{"key":"ref21","doi-asserted-by":"publisher","first-page":"e001084","DOI":"10.1161\/SVIN.123.001084","article-title":"Is thrombectomy worth it for isolated posterior cerebral artery occlusion? Meta-analysis and trial sequential analysis","volume":"4","author":"Jhou","year":"2024","journal-title":"Stroke Vasc Interv Neurol"},{"key":"ref22","doi-asserted-by":"publisher","first-page":"508","DOI":"10.1186\/s12883-025-04512-x","article-title":"Endovascular therapy versus medical management in posterior cerebral artery stroke: neurological gains without functional superiority: a meta-analysis","volume":"25","author":"Moawad","year":"2025","journal-title":"BMC Neurol"},{"key":"ref23","doi-asserted-by":"publisher","first-page":"e71194","DOI":"10.1002\/brb3.71194","article-title":"Endovascular therapy versus best medical treatment in posterior cerebral artery stroke: a systematic review and meta-analysis","volume":"16","author":"Alam","year":"2026","journal-title":"Brain Behav"},{"key":"ref24","doi-asserted-by":"publisher","first-page":"2371","DOI":"10.1212\/01.wnl.0000304346.14354.0b","article-title":"Baseline NIH stroke scale score predicting outcome in anterior and posterior circulation strokes","volume":"70","author":"Sato","year":"2008","journal-title":"Neurology"},{"key":"ref25","doi-asserted-by":"publisher","first-page":"855","DOI":"10.1007\/s00415-002-0742-0","article-title":"Pure superficial posterior cerebral artery territory infarction in the Lausanne stroke registry","volume":"249","author":"Cals","year":"2002","journal-title":"J Neurol"},{"key":"ref26","doi-asserted-by":"publisher","first-page":"117585","DOI":"10.1016\/j.jns.2021.117585","article-title":"Lesion topography of posterior cerebral artery infarcts","volume":"428","author":"Benke","year":"2021","journal-title":"J Neurol Sci"},{"key":"ref27","doi-asserted-by":"publisher","first-page":"682827","DOI":"10.3389\/fneur.2021.682827","article-title":"Pitfalls in the diagnosis of posterior circulation stroke in the emergency setting","volume":"12","author":"Hoyer","year":"2021","journal-title":"Front Neurol"},{"key":"ref28","doi-asserted-by":"publisher","first-page":"157","DOI":"10.1159\/000513098","article-title":"Cognitive and behavioral disorders in patients with precuneal infarcts","volume":"84","author":"Kumral","year":"2021","journal-title":"Eur Neurol"},{"key":"ref29","doi-asserted-by":"publisher","first-page":"571","DOI":"10.1007\/s004150050146","article-title":"Mechanisms of infarction in the superficial posterior cerebral artery territory","volume":"244","author":"Steinke","year":"1997","journal-title":"J Neurol"},{"key":"ref30","doi-asserted-by":"publisher","first-page":"106518","DOI":"10.1016\/j.jstrokecerebrovasdis.2022.106518","article-title":"Mechanisms of stroke in patients with fetal posterior cerebral artery","volume":"31","author":"Ryu","year":"2022","journal-title":"J Stroke Cerebrovasc Dis"},{"key":"ref31","doi-asserted-by":"publisher","first-page":"158","DOI":"10.1016\/j.jocn.2019.07.006","article-title":"Fetal origin of posterior cerebral artery related to poor collaterals in patients with acute ischemic stroke","volume":"68","author":"Dharmasaroja","year":"2019","journal-title":"J Clin Neurosci"},{"key":"ref32","doi-asserted-by":"publisher","first-page":"1565","DOI":"10.1056\/NEJM199406023302204","article-title":"The anatomy of the posterior communicating artery as a risk factor for ischemic cerebral infarction","volume":"330","author":"Schomer","year":"1994","journal-title":"N Engl J Med"},{"key":"ref33","doi-asserted-by":"publisher","first-page":"343","DOI":"10.1111\/jon.12503","article-title":"Clinical and neuroimaging findings in thalamic territory infarctions: a review","volume":"28","author":"Li","year":"2018","journal-title":"J Neuroimaging"}],"container-title":["Frontiers in Neurology"],"original-title":[],"link":[{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fneur.2026.1807618\/full","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,4,21]],"date-time":"2026-04-21T14:35:32Z","timestamp":1776782132000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fneur.2026.1807618\/full"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,4,21]]},"references-count":33,"alternative-id":["10.3389\/fneur.2026.1807618"],"URL":"https:\/\/doi.org\/10.3389\/fneur.2026.1807618","relation":{},"ISSN":["1664-2295"],"issn-type":[{"value":"1664-2295","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,4,21]]},"article-number":"1807618"}}