PANTHER: Prasugrel-based aneurysm treatment with non-identical telescoping with flow diversion with hydrophilic polymer coating for endovascular reconstruction in acute subarachnoid hemorrhage

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.