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Introduction Stent-assisted coiling (SAC) is widely used for treating wide-necked intracranial aneurysms and is increasingly applied in acutely ruptured cases. The pEGASUS-HPC, a low-profile stent with an antithrombogenic hydrophilic polymer coating, offers potential advantages in reducing thromboembolic events while promoting durable aneurysm occlusion.Aim of study To evaluate the clinical and radiological outcomes of SAC using the pEGASUS-HPC stent in patients with acutely ruptured wide-necked intracranial aneurysms.Method This retrospective multicenter study (July 2021 to June 2024) included 22 patients with acutely ruptured wide-necked intracranial aneurysms treated with the pEGASUS-HPC stent. Demographic, clinical, procedural, and follow-up data were analyzed. Primary outcomes included procedural success, extent of aneurysmal occlusion, and changes in modified Rankin Scale (mRS) scores. Secondary outcomes comprised complication rates, including cerebral infarction and stent thrombosis.Results The cohort mean age was 63.4 ± 12.5 years, with 68% female patients. Aneurysms were almost evenly distributed between the anterior and posterior circulation (59% anterior). Stent-assisted coiling was successful in all cases, with a significant improvement in modified Rankin Scale (mRS) scores from baseline (3.36 ± 1.76) to last follow-up (1.73 ± 2.55). Device-related complications occurred in 18% of cases, primarily cerebral infarction (9%).Conclusion The pEGASUS-HPC stent demonstrates robust efficacy and safety for SAC in acutely ruptured wide-necked intracranial aneurysms, achieving significant functional recovery and low complication rates. These findings support its role in optimizing endovascular treatment strategies. Future prospective studies are needed to confirm these outcomes and explore long-term benefits.Conflict of Interest No