pEGASUS-HPC Stent Pusher-Assisted Catheterization (PAC) Technique in Y-Stent-Assisted Coiling of Unruptured Wide-Necked Cerebral Aneurysms: A Multicenter Retrospective Study

Abstract Objectives: To evaluate the safety and efficacy of the pusher-assisted catheterization (PAC) technique using the pEGASUS-HPC stent pusher instead of a microwire for accessing unruptured wide-necked cerebral aneurysms during Y-stent-assisted coiling. Methods: In this multicenter retrospective study (July 2021– June 2025), 48 unruptured wide-necked cerebral aneurysms underwent Y-stent-assisted coiling using pEGASUS HPC stents. Based on the catheterization technique, cases were assigned to either the microwire-assisted catheterization (MAC, n=23) or the stent pusher-assisted catheterization (PAC, n=25) 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 had a mean age of 62.6 ± 9.8 years, with 64.3% of patients being female. In the MAC group, aneurysm catheterization was successful in all 23 cases (100%), with a mean catheterization time of 5.31 ± 1.2 minutes. In contrast, the PAC group achieved successful catheterization in 88% of cases (22/25), with a markedly reduced mean catheterization time of 0.82 ± 0.27 minutes—approximately 6.5 times faster than the conventional MAC technique (p < 0.001). Importantly, no procedure-related complications, such as perforations or dissections, were observed in either group. Conclusion: The PAC technique using the pEGASUS-HPC stent appears to be a safe and time-efficient alternative to microwire-assisted catheterization in Y-stent-assisted coiling of unruptured wide-necked cerebral aneurysms. It significantly reduces catheterization time without increasing complication rates. Further studies are needed to confirm these preliminary findings.