pEGASUS HPC stent pusher-assisted catheterization (PAC) of nonruptured cerebral aneurysms: Safety and efficacy

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.