Comparison of pEGASUS-HPC stent pusher-assisted catheterization (PAC) in ruptured and unruptured wide-necked cerebral aneurysms: a multicenter study

OBJECTIVES: To compare the feasibility, efficiency, and safety of the pEGASUS-HPC stent pusher-assisted catheterization (PAC) technique between ruptured and unruptured wide-neck intracranial aneurysms treated with stent-assisted coiling. METHODS: Multicenter retrospective study (June 2021-June 2025) evaluating the pEGASUS-HPC PAC technique in ruptured and unruptured wide-neck intracranial aneurysms treated with stent-assisted coiling. A microwire-assisted catheterization (MAC) cohort was included as a reference cohort. Primary endpoints were catheterization success and catheterization time; safety endpoints included perforation, dissection, and vasospasm. RESULTS: A total of 151 patients with 186 aneurysms were analyzed, including a PAC cohort of 91 patients with 111 aneurysms (27 ruptured, 84 unruptured) and a MAC reference cohort of 60 patients with 75 unruptured aneurysms. Catheterization success was achieved in 26/27 ruptured aneurysms (96.3%) and 79/84 unruptured aneurysms (94.0%) (p = 0.637). Mean catheterization time was 44 ± 14 s in ruptured aneurysms and 43 ± 21 s in unruptured aneurysms (p = 0.78). No catheterization-related perforations or dissections occurred in either PAC group, and no major procedural complications were recorded. Compared with the MAC reference cohort (289 ± 78 s), PAC was associated with significantly shorter catheterization times in both ruptured and unruptured aneurysms (both p < 0.001) while maintaining high technical success rates. CONCLUSION: The PAC technique demonstrated high catheterization success rates, short catheterization times, and a favorable safety profile in both ruptured and unruptured wide-neck intracranial aneurysms. Aneurysm rupture status did not significantly influence procedural performance or safety. Larger prospective studies are warranted to confirm these findings and further define patient- and anatomy-specific indications for the technique.