Purpose: To compare the efficacy and safety of the pEGASUS-HPC and CREDO heal coated stent systems used with the NeuroSpeed percutaneous angioplasty (PTA) balloon catheter, for treating acute symptomatic intracranial artery stenosis (ICAS) with or without acute vessel occlusion (VO). Methods: This retrospective, multicenter study included patients with ICAS between June-2021 and June-2024 treated with the NeuroSpeed PTA balloon catheter and either stent system. Clinical endpoints included National Institutes of Health Stroke Scale (NIHSS) scores and modified ranking scores (mRS), safety and efficacy endpoints included in-stent thrombosis and in-stent stenosis. Results: Sixty-nine patients were included (pEGASUS-HPC, n = 34; CREDO heal, n = 35). Both groups showed significant improvement in arterial diameter post-intervention (pEGASUS-HPC: 0.47 mm (SD 0.27 mm) to 1.69 mm (SD 0.55 mm); CREDO heal: 0.57 mm (SD 0.41 mm) to 1.89 mm (SD 0.62 mm)). Revascularization success, defined as residual stenosis < 50%, was achieved in 32/34 (93.9%) patients in the pEGASUS-HPC group and 33/35 (94.3%) in the CREDO heal group. In-stent re-stenosis occurred in 5/34 (14.7%) of patients in the pEGASUS-HPC group and 2/35 (5.7%) in the CREDO heal group and retreatment with PTA was performed in 3/34 (8.8%) and 2/35 (5.7%), respectively. Peri- or postprocedural in-stent thrombosis occurred in 3/34 (8.8%) of patients in the pEGASUS-HPC group and 2/35 (5.7%) in the CREDO heal group. At 3–6 months, the proportion of patients achieving an mRS score of 0–2 was 25/34 (73.5%) in the pEGASUS-HPC group and 28/35 (80.0%) in the CREDO heal group ( p = 0.578). Conclusion: Both stent systems proved effective and safe, showing significant post-intervention arterial dilation, high revascularization rates, and similar functional outcomes (mRS 0–2 at 3–6 months), though they differed in in-stent restenosis rates.

Objectives: To investigate the safety and efficacy of using the pEGASUS HPC stent pusher instead of a microwire for catheterization of nonruptured cerebral aneurysms during stent-assisted coiling. Methods: In this multicenter retrospective study (July 2021–June 2024), 107 patients with 118 incidental nonruptured cerebral aneurysms underwent stent-assisted coiling using pEGASUS HPC stents. Based on the catheterization technique, cases were assigned to either the microwire-assisted catheterization (MAC, n = 58) or the stent pusher-assisted catheterization (PAC, n = 60) group. Clinical and procedural data were analyzed to compare safety and efficacy, focusing on success rates, required catheterization time, complications, and adverse events. Results: The cohort (mean age 59 ± 13.2 years; 52.3% female). In the MAC group, aneurysm catheterization was successful in all cases (100%), with one procedure-related perforation caused by the microwire (1.7%). In contrast, the PAC group achieved a slightly lower success rate of 95% (57/60), but no perforations were observed. The mean catheterization time was significantly shorter in the PAC group (0.67 ± 0.24 minutes) compared to the MAC group (4.43 ± 0.59 minutes), demonstrating that PAC is approximately seven times faster. No other relevant complications were reported. Conclusion: PAC with the pEGASUS HPC stent pusher appears safe and effective for catheterizing nonruptured cerebral aneurysms, with high success, no perforations, and significantly shorter catheterization time. Larger prospective studies are needed to confirm these results.

Purpose To evaluate the safety, efficacy, and clinical outcomes of stent-assisted coiling (SAC) and flow diversion (FD) with hydrophilic polymer-coated (HPC) devices under prasugrel single antiplatelet therapy (SAPT) in the treatment of acutely ruptured wide-neck intracranial aneurysms. Methods This multicenter retrospective case series included patients with ruptured saccular intracranial aneurysms treated through SAC or FD with HPC-coated devices under SAPT at four specialized neurovascular centers. Baseline demographics, aneurysm characteristics, procedural details, and clinical outcomes were analyzed. The primary outcomes included technical success, periprocedural complications, aneurysm occlusion rates at follow-up (FU), and functional outcomes assessed with the modified Rankin Scale (mRS). Results A total of 46 patients were included (mean age 57.4 years). SAC and FD were performed in equal proportions. Technical success was achieved in 100% of cases. The immediate complete occlusion rate was significantly higher for SAC (95.7%) than FD (21.7%, p < 0.001). However, the occlusion rates at 12-month FU were comparable (SAC 100% vs. FD 95%, p = 0.364). The overall periprocedural complication rate was low (4.3%), and mortality before discharge was 10.9%. Favorable functional outcomes (mRS ≤ 2) at the last FU were achieved in 84% of patients, and no significant differences were observed between the SAC and FD groups. Conclusion SAC and FD with HPC-coated devices under prasugrel SAPT appeared to be safe and effective in treating ruptured wide-neck aneurysms. Whereas SAC achieved higher immediate occlusion rates, the long-term outcomes were comparable between groups. These findings support the feasibility of SAPT in this high-risk population and warrant further prospective validation.

Background: Stent-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. Methods: Between 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. Results: Stent 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. Conclusion: The 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.

Objectives: Y-stent-assisted coiling (Y-SAC) is an established technique for managing wide-necked intracranial bifurcation aneurysms. However, data on the use of the pEGASUS stent, a self-expanding open-cell stent with an antithrombogenic hydrophilic polymer coating, remain limited. This study evaluated the effectiveness and safety of Y-SAC with pEGASUS stents in patients with intracranial bifurcation aneurysms. Methods: This retrospective observational study included patients treated with Y-SAC with pEGASUS stents at six neurovascular centers between July 2021 and June 2024. Data on aneurysm characteristics, procedural details, and clinical outcomes were collected. Aneurysm occlusion was assessed with the modified Raymond-Roy classification (MRRC) at 6 and 12 months. The primary endpoint was complete aneurysm occlusion (MRRC I), whereas secondary endpoints included perioperative complications, functional outcomes, and retreatment rates. Results: A total of 40 patients (mean age: 61.6 ± 9.4 years; 60% women) were included. Immediately post-procedure, 100% of aneurysms achieved complete occlusion (MRRC I). At 6–12 months follow-up, 92.5% maintained MRRC I occlusion, and 2.5% exhibited neck remnants (MRRC II). Functional outcomes were favorable in 95% of patients at discharge. The overall complication rate was 4.8%, and one patient (2.5%) required retreatment. No periprocedural thromboembolic events were observed. Conclusions: Our findings indicated that Y-SAC with pEGASUS stents achieves high rates of durable aneurysm occlusion with minimal complications, thus supporting its use as a safe and effective strategy for wide-necked bifurcation aneurysms. Future prospective studies are needed to validate long-term outcomes and optimize treatment strategies.

Purpose: The objective of this study is to report the initial experience with the PANTHER technique for ruptured intracranial aneurysms and to provide a descriptive comparison with patients treated using a single flow diverter (FD) under prasugrel single antiplatelet therapy (SAPT). Methods: A retrospective analysis was conducted on patients with subarachnoid hemorrhage due to ruptured wide-neck aneurysms. The PANTHER group ( n = 8) underwent reconstruction with non-identical telescoping hydrophilic polymer–coated (HPC) FDs under prasugrel SAPT. For the purpose of comparison, the outcomes of patients treated with a single HPC-coated FD ( n = 21) were reviewed. The data included complications, angiographic occlusion, and clinical outcomes. Results: The PANTHER procedures were technically successful, without procedure-related hemorrhagic, ischemic, or thromboembolic complications. At early follow-up (median 5 months), complete occlusion was observed in all available PANTHER cases, whereas in the single FD group, 77.8% of assessable aneurysms showed complete occlusion. At long-term follow-up, complete occlusion was documented in both groups. Conclusion: In this single-center series, the PANTHER technique was technically feasible and associated with high early occlusion rates and favorable clinical outcomes under prasugrel SAPT. A descriptive comparison with single FD treatment suggests a potential hemodynamic benefit of non-identical telescoping constructs. Larger prospective studies are warranted to validate these preliminary findings.