Comparing Efficacy and Safety of Endovascular Thrombectomy Versus Best Medical Management in Acute Isolated Posterior Cerebral Artery Occlusion Stroke: A Systematic Review and Meta-analysis

Background Isolated posterior cerebral artery occlusion (iPCAO) stroke is an important cause of cognitive and visual impairments. The effectiveness and safety of endovascular thrombectomy (EVT) for iPCAO are still unclear, so this meta-analysis was conducted to evaluate its efficacy and safety. Methods PubMed, Cochrane Central, and ScienceDirect were searched till May 2025. The risk ratios (RR) along with 95% confidence interval (CI) were pooled under a random effects model using the Review Manager version 5.4.1. Quality assessment was done using the Newcastle Ottawa Scale, whereas the publication bias was assessed using the funnel plots. Results Ten observational studies were included in this meta-analysis. The EVT was associated with significantly increased early neurological improvement (ENI) compared to BMM (RR= 1.42; 95%CI; [1.32, 1.54]; p <0.00001; I ² = 0%). Whereas the visual field normalization was comparable between EVT and BMM (RR= 1.44; 95%CI; [0.96, 2.15]; p = 0.08; I ² = 68%). The safety measures, including symptomatic intracranial hemorrhage (sICH) (RR= 2.00; 95%CI; [1.07, 3.71]; p = 0.03; I ² = 46%) and mortality (RR= 1.57; 95%CI; [1.09, 2.26]; p = 0.01; I ² = 33%), showed a significant increase in the EVT arm. Functional outcomes, including excellent (RR= 1.05; 95%CI; [0.95, 1.15]; p = 0.36; I ² = 0%) and good (RR= 0.92; 95%CI; [0.84, 1.00]; p = 0.05; I ² = 51%) functional outcome, were comparable between the two groups. Conclusion EVT was linked to higher ENI, but it also had significantly increased risks of sICH and mortality. However, the visual field normalization and functional outcomes, including excellent and good, were similar between EVT and BMM in iPCAO patients.