Klinische Anwendung und Evaluierung des pEGASUS-HPC-Stents im Rahmen kombinierter neurointerventioneller Therapien bei rupturierten intrakraniellen Aneurysmen und akuter intrakranieller Stenose
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Abstract
Summary
The aim of this cumulative dissertation was the clinical evaluation of HPC-coated intracranial stents in acute neurointerventional settings. The focus was on the use of the pEGASUS-HPC stent for the treatment of ruptured intracranial aneurysms and acute intracranial atherosclerotic stenosis (ICAS). Particular attention was given to the feasibility of treatment under reduced antiplatelet therapy (single antiplatelet therapy [SAPT] or shortened dual antiplatelet therapy [DAPT]) in hemostatically critical situations.
Methods
This dissertation comprises two multicenter retrospective studies:
SAC Study (22 patients): Treatment of ruptured wide-neck intracranial aneurysms using stent-assisted coiling (SAC) with the pEGASUS-HPC stent under prasugrel monotherapy.
ICAS Study (69 patients): Comparison of the pEGASUS-HPC and CREDO Heal stents for acute revascularization of symptomatic ICAS using percutaneous transluminal angioplasty (PTA) and stent implantation under modified antiplatelet therapy.
Primary endpoints included technical success rates, angiographic outcomes, procedure-related complications, and functional outcomes measured by the modified Rankin Scale (mRS).
Results
SAC Study:
The technical success rate was 100%. Immediate complete aneurysm occlusion was achieved in more than 80% of cases, with stable occlusion rates exceeding 90% during follow-up. The median mRS improved significantly from 3 (IQR 2–5) to 0 (IQR 0–1; p = 0.002). The complication rate was 9.1%, including one transient in-stent thrombosis and one radiological rebleeding event, neither of which resulted in clinical deterioration.
ICAS Study:
Successful reperfusion (TICI ≥ 2b) was achieved in approximately 90% of patients in both stent groups. Functional outcomes were favorable, with mRS scores of 0–2 observed in 73.5% of patients treated with pEGASUS-HPC and 80% of those treated with CREDO Heal. Complications included in-stent thrombosis (6–9%), restenosis (~15%), and retreatment rates of approximately 10%. No statistically significant differences were observed between the two stent types.
Conclusion
The findings demonstrate that HPC-coated stents represent a safe and effective treatment option in acute neurovascular emergencies, both for ruptured intracranial aneurysms and for symptomatic ICAS. High technical success rates and favorable occlusion/reperfusion outcomes were achieved under reduced antiplatelet regimens, including SAPT, while maintaining low complication rates. These results support the feasibility of individualized antithrombotic strategies in acute neurointerventional management and expand therapeutic options for patients in hemostatically critical conditions.
Keywords: Intracranial aneurysm, subarachnoid hemorrhage, intracranial atherosclerotic stenosis (ICAS), HPC coating, pEGASUS stent, CREDO Heal, stent-assisted coiling, single antiplatelet therapy (SAPT), dual antiplatelet therapy (DAPT), acute endovascular treatment.
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Issued: 2026-05-19
Relations
Is based on: 10.1007/s00062-025-01544-1; 10.1177/15910199251357993
Faculty
FB20:Medizin
Language
de
Keywords
CREDO heal stentIntracranial artery stenosisVessel OcclusionPercutaneous transluminal angioplastyaneurysmcoilingsubarachnoid hemorrhage
DFG-subjects
2.22-30 - Radiologie
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Ali, Zakarya: Klinische Anwendung und Evaluierung des pEGASUS-HPC-Stents im Rahmen kombinierter neurointerventioneller Therapien bei rupturierten intrakraniellen Aneurysmen und akuter intrakranieller Stenose. : 2026-05-19.
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This item has been published with the following license: In Copyright