Y-Stent Placement as a Possibly Useful Bailout Technique for Coil Protrusion into Parent Artery in Coil Embolization: A Case Report.

Objective: Stent placement is sometimes used as a bailout strategy to preserve the parent vessel during coil embolization of cerebral aneurysms. However, in more challenging situations, a Y-stent configuration may be required, although its safety and efficacy remain uncertain, and no consensus has been established. This report describes a case in which Y-stent placement was used as a bailout strategy after coil deviation into the parent artery during endovascular treatment for a ruptured intracranial aneurysm. Case Presentation: A 41-year-old man presented to our hospital with the sudden onset of a severe headache. He was diagnosed with a subarachnoid hemorrhage caused by a ruptured wide-necked anterior communicating artery aneurysm and was transferred to our hospital for emergency coil embolization. During the procedure, the coil mass deviated from the parent artery, resulting in bilateral A2 occlusion. To restore blood flow, a bailout Y-stent technique was performed. Following antiplatelet loading, a Neuroform Atlas stent (Stryker, Kalamazoo, MI, USA) was deployed from the right A2 to A1, and this was followed by a 2nd Neuroform Atlas stent from the left A2 to A1, forming a Y configuration. Subsequently, sedation management was administered. Three days later, additional coil embolization was performed to achieve complete aneurysm occlusion. The patient recovered without neurological deficits, and dual antiplatelet therapy was gradually tapered. Follow-up cerebral angiography at 2 years confirmed complete aneurysm occlusion. Conclusion: The Y-stent technique served as an effective bailout strategy for coil deviation in the wide-necked aneurysm, demonstrating favorable long-term outcomes. This case suggests that the Y-stent technique can provide a viable option for managing wide-necked aneurysms when coil deviation occurs.