Antithrombogenic coated self-expanding stent (pEGASUS-HPC) for the treatment of intracranial dissections of the cerebral arteries in acute stroke: a multicenter study

BACKGROUND: Intracranial artery dissection (IADS) is an uncommon cause of acute ischemic stroke (AIS). In hyperacute settings, stenting is constrained by the need for intensive antiplatelet therapy. This study evaluated the antithrombogenic hydrophilic polymer-coated pEGASUS-HPC self-expanding stent for IADS-related AIS. METHODS: This multicenter retrospective cohort study across seven stroke centers included consecutive patients with AIS and occlusion or severe flow-limiting stenosis caused by symptomatic IADS, who were treated with the pEGASUS-HPC. The outcomes were technical and angiographic success (device opening; mTICI score ≥2b when reperfusion was targeted), peri-procedural complications, mRS score, and follow-up patency. RESULTS: In 36 treated patients (mean age 62.0 ± 19.6 years; 63.9% men), 91.7% of the dissections were spontaneous, and 80.6% were occlusive. Mechanical thrombectomy preceded stenting in 26/29 occlusive cases. Full stent opening occurred in 94.4%, and 100% reperfusion success was achieved in targeted vessels. Most patients received periprocedural intravenous antiplatelet bridging (75.0%) and were discharged on DAPT (77.8%). Whereas no intraprocedural complications occurred, four postprocedural events occurred during admission (11.1%), of which two were clinically significant and two were minor and asymptomatic. The mean NIHSS score improved from 11.8 at admission to 4.9 at discharge, and the mean discharge mRS score was 2.1. Clinical follow-up (mRS) was available in 33/36 patients (91.7%), with favorable functional outcome (mRS 0-2) in 27/33 (81.8%). Imaging follow-up at the early window (mean 94 days) was available in 27/36 (75.0%). In-stent stenosis ≥ 50% occurred in 14.8% and 4.2% of patients at early and mid-term follow-up, respectively, whereas no device occlusions or recurrent strokes occurred through mid-term follow-up. Long-term imaging follow-up (15/36, 41.7%) showed no new in-stent stenosis. CONCLUSIONS: pEGASUS-HPC stenting for IADS-related AIS was technically feasible and achieved high reperfusion rates and a low overall complication burden, thus supporting prospective evaluation with standardized antiplatelet protocols.