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Introduction Mechanical thrombectomy is well-established for large vessel occlusions, but its use in distal vessel occlusions (DVOs) remains controversial. Current literature often advises against intervention due to concerns over safety and uncertain clinical benefit.Aim of Study To evaluate the safety and effectiveness of mechanical thrombectomy in patients with primary DVOs and assess their clinical outcomes.Method We retrospectively analyzed 18 patients with acute ischemic stroke due to primary DVOs, treated at a single center in Milan using mechanical thrombectomy. We assessed recanalization success (mTICI score), neurological improvement (NIHSS), and functional outcomes (mRS at 90 days), along with procedural safety.Abstract A113 Figure 1Results Successful reperfusion (mTICI 2c/3) was achieved in 94% of the patients. Significant clinical improvement was noted, with 80% achieving mRS ≤2 at 90 days. No symptomatic intracranial hemorrhages occurred, and we reported no periprocedural complications. Only two patentis died for non neurological clinical compications.Abstract A113 Figure 2Conclusion Despite existing literature, and especially the last trial, cautioning against thrombectomy in DVOs, our findings suggest that mechanical thrombectomy is both safe and effective in selected patients.Conflict of Interest No