Purpose: Portal vein tumor thrombosis (PVT) is a late stage complication of infiltrative hepatocellular carcinoma (HCC), common in patients. Limited treatment options are available for patients with hepatocellular carcinoma with PVT. We present our initial experience treating such patients with 90Y radioembolization. Materials and Methods: From August 2011 to February 2013, 31 patients with hepatitis C and HCC with PVT treated by 90Y radioembolization were retrospectively reviewed. Tumor involves the main portal vein in 5 (16.1%) patients, lobar PV in 16 (51.7%) patients, and segmental PV in 10 (32.3%) patients. 36 treatment sessions were performed on 31 patients. 8 patients (25.8%) received whole liver treatment, and the remainder received segmental or lobar treatment. Median dose delivered was 1.92 GBq (range, 0.21–4.96 GBq). 14 patients (45%) started sorafenib treatment one week after radioembolization. Clinical and biochemical toxicities were recorded. Tumor response was evaluated using RECIST and mRECIST criteria. Survival statistics were calculated. Results: The main clinical toxicity was fatigue (54.8%). One patient experienced grade 3 bilirubin toxicity, and none experienced gastroduodenal ulcers. Overall and PVT response rates by RECIST were 56.5% and 60.9% and by mRECIST 73.9% each, respectively. Overall mean and median survival were 16.2 months and 7 months. Mean survival stratified by the location of PVT was 21.5, 10.7 and 19.6 months for segmental, lobar and main PVT patients (p=0.256). Patients who died did so from progressive intrahepatic disease. Using univariate analysis, ECOG performance status (p=0.016, HR=3.262), lobar involvement (p=0.036, HR=2.689), serum bilirubin (p<0.0001, HR=6.971) and presence of extrahepatic metastasis (p=0.046, HR=2.896) correlated with survival Conclusion: 90Y radioembolization treatment for patients with HCC complicated by PVT is safe and results in a very high rate of radiologic response and very encouraging survival statistics.