Pegasus stent as a rescue therapy in large vessel occlusions with underlying intracranial atherosclerosis: a retrospective Single-Center experience.

Abstract

Purpose: Large vessel occlusions (LVOs) due to underlying intracranial atherosclerotic disease (ICAD) are associated with higher rates of mechanical thrombectomy (MT) failure and worse clinical outcomes. The pEGASUS-HPC stent is a novel low-profile device with a hydrophilic polymer coating designed to reduce thrombogenicity. Evidence regarding its use in ICAD-related LVOs is currently limited.

Methods: We conducted a retrospective single-center study to evaluate the safety and efficacy of the pEGASUS-HPC stent as a rescue treatment following MT failure in ICAD-related LVOs.

Results: From December 2022 to December 2024 among 393 thrombectomies performed, 25 patients met the inclusion criteria. The mean age was 66 years (53-90) and 18/25 (72%) were men. The anterior circulation was involved in most cases (17/25, 68%). Median baseline NIHSS was 8 and ASPECTS was 9. Rescue stenting was performed due to persistent occlusion (28%), residual stenosis (56%), or early reocclusion (16%). Final TICI 2b-3 recanalization was achieved in 92% of cases. Pre-stenting angioplasty was performed in 32% and post-stenting in 16% of cases. Periprocedural complications occurred in 16% of patients. Median NIHSS at 24 h was 5 and the median ASPECTS was 8. At 24 h, only 1/25 patients demonstrate in-stent thrombosis. Long-term follow-up (6 months) was available for 76% of patients; stent patency was maintained in all, and 84% achieved a favorable outcome (mRS < 2 at 90 days).

Conclusion: Rescue stenting with the pEGASUS-HPC stent in selected cases of ICAD-related LVO appears to be a feasible and effective treatment option after MT failure, with high recanalization rates, favorable clinical outcomes, and acceptable complication rates.