Stent-assisted coiling using the pEGASUS-HPC stent for acutely ruptured wide-necked intracranial aneurysms: A multicenter retrospective study

Abstract

BackgroundStent-assisted coiling (SAC) is increasingly used to treat ruptured wide-necked intracranial aneurysms. The pEGASUS-HPC stent, featuring a hydrophilic polymer coating (HPC) to reduce thrombogenicity, may offer a safe option in subarachnoid hemorrhage (SAH). This study evaluates its safety and efficacy in a multicenter retrospective cohort.MethodsBetween July 2021 and June 2024, 22 patients with ruptured wide-necked aneurysms were treated with pEGASUS-HPC SAC at four neurovascular centers. Procedural success, aneurysm occlusion (Modified Raymond-Roy Classification, MRRC), and clinical outcomes based on the modified Rankin Scale (mRS) at discharge and follow-up were assessed. Complications and mortality were analyzed in relation to clinical and procedural factors.ResultsStent implantation and coil embolization were successfully performed in all patients. Immediate complete occlusion (MRRC I) was achieved in 19 cases (86.4%) and reached 100% at the 3-month follow-up. The median mRS improved from 3 (2-5) at discharge to 0 (0-2) at 3 months and 0 (0-1) at final follow-up, indicating sustained recovery. In 27.3% of cases, Y-stenting was required, reflecting bifurcation complexity. One patient (4.6%) had transient in-stent thrombosis, which resolved with tirofiban. All complications were minor and managed conservatively. No retreatment was required. All three deaths (13.6%) occurred in patients with Hunt and Hess grade V and basilar artery aneurysms.ConclusionThe pEGASUS-HPC stent showed a favorable safety profile with high occlusion and recovery rates in ruptured wide-necked aneurysms. These findings support the use of surface-modified stents in the acute setting and highlight the need for prospective studies to confirm long-term safety and efficacy.

Keywords: aneurysm; coiling; pEGASUS-HPC; stent; subarachnoid hemorrhage.

Figure 1.

Digital subtraction angiography (DSA) demonstrating a wide-necked, ruptured aneurysm at the intradural terminal segment of the right internal carotid artery (ICA), treated with pEGASUS-HPC stent-assisted coiling. 1 – Ruptured ICA aneurysm. 2 – Presumed rupture site. 3 – ICA. 4 – Middle cerebral artery (MCA). 5 – Anterior cerebral artery (ACA). 6 – Ophthalmic artery. 7 – Distal stent markers. 8 – Proximal stent markers. 9 – Coiled aneurysm. (A) Pre-treatment angiogram showing vascular anatomy prior to stent and coil deployment. (B) Angiogram immediately after pEGASUS-HPC stent placement, with visible distal and proximal stent markers, but before coil embolization. (C) Post-coiling angiogram showing complete occlusion of the aneurysm sac with no procedural complications. (D) Follow-up DSA at 3 months confirming stable, complete aneurysm occlusion.

Figure 2.

Digital subtraction angiography (DSA) of a wide-necked, ruptured aneurysm at the bifurcation of the middle cerebral artery (MCA), treated with stent-assisted coiling (SAC) using two pEGASUS-HPC stents in a Y-configuration. 1 – M1 segment of the MCA. 2 – Anterior M2 branch. 3 – Posterior M2 branch. 4 – Ruptured MCA aneurysm. 5 – Coiled aneurysm. 6 – Distal markers of the anterior pEGASUS-HPC stent. 7 – Distal markers of the posterior pEGASUS-HPC stent. 8 – Proximal markers of both pEGASUS-HPC stents. (A) Pre-treatment angiogram illustrating the vascular anatomy before stent and coil placement. (B) Final angiogram after SAC, demonstrating complete occlusion of the aneurysm sac without procedural complications. (C) Angiogram following deployment of both pEGASUS-HPC stents in Y-configuration and coil embolization, with clearly visible proximal and distal stent markers.