# pEGASUS-HPC stent pusher assisted catheterization (PAC) technique in Y-stent-assisted coiling of unruptured wide-necked cerebral aneurysms

## TL;DR

A new technique using a stent pusher instead of a microwire speeds up catheterization for treating cerebral aneurysms without increasing complications.

## Contribution

Introduces a stent pusher-assisted catheterization technique that significantly reduces procedure time for aneurysm treatment.

## Key findings

- Stent pusher-assisted catheterization reduced mean catheterization time by 6.5 times compared to microwire-assisted methods.
- No procedure-related complications were observed in either the stent pusher or microwire-assisted groups.
- The technique shows technical feasibility but requires further validation in outcome-driven studies.

## Abstract

To evaluate the safety and feasibility 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.

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.

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 min. 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 min—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.

In this multicenter retrospective feasibility and safety analysis, PAC appeared to enable faster aneurysm access during Y-stent-assisted coiling without an increase in intraprocedural complications. As clinical outcomes were not assessed, these findings should be regarded as technical proof-of-concept and require confirmation in prospective, outcome-driven studies.