Safety and efficacy of stent-assisted coiling with the pEGASUS-HPC stent in wide-necked intracranial aneurysms: a multicenter retrospective analysis.

Background: Stent-assisted coiling is widely used for the treatment of wide-necked intracranial aneurysms. The pEGASUS-HPC stent features a hydrophilic polymer coating designed to reduce thrombogenicity, potentially improving safety, particularly in ruptured aneurysms and complex configurations.

Objective: To evaluate the safety, efficacy, and technical feasibility of stent-assisted coiling using the pEGASUS-HPC stent in the treatment of wide-necked intracranial aneurysms.

Methods: We retrospectively analyzed 223 patients with 251 wide-necked aneurysms treated at six centers between July 2021 and March 2025. Primary endpoints included angiographic occlusion (modified Raymond-Roy classification, MRRC), periprocedural complications, and clinical outcome (modified Rankin Scale, mRS) at discharge and follow-up. Subgroup analysis was performed for ruptured aneurysms and bifurcation cases requiring Y-stenting.

Results: Stent deployment and coiling were technically successful in all cases. Immediate complete occlusion (MRRC I) was achieved in 92.4% of aneurysms, increasing to 96.8% at follow-up. The overall retreatment rate was 2.2%. Periprocedural complications occurred in 1.6% of cases, consisting of two minor perforations in unruptured aneurysms, both managed without clinical consequences. In ruptured cases a favorable outcome (mRS ≤2) was observed in 71.1%, with mortality confined to Hunt and Hess grade V or basilar artery aneurysms. Y-stenting was performed in 15.9% of cases without technical failure. No perforations occurred in ruptured cases.

Conclusion: Stent-assisted coiling with the pEGASUS-HPC stent appears technically feasible and effective for wide-necked aneurysms, including acute ruptured cases and those requiring Y-stenting, with high occlusion rates and low complication rates.