{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,2,14]],"date-time":"2026-02-14T21:23:59Z","timestamp":1771104239559,"version":"3.50.1"},"reference-count":15,"publisher":"Scientific Scholar","content-domain":{"domain":["surgicalneurologyint.com"],"crossmark-restriction":true},"short-container-title":[],"abstract":"\nBackground<\/jats:title>\nThe endovascular treatment of complex middle cerebral artery (MCA) aneurysms, particularly dysplastic large MCA bifurcation aneurysms, can pose significant technical challenges. We aim to present three cases illustrating the technical nuances and challenges often encountered in Y-stent-assisted coiling (Y-SAC) for such aneurysms and provide an update on technical nuances.<\/jats:p>\n<\/jats:sec>\n\nMethods<\/jats:title>\nWe present three consecutive cases of dysplastic MCA aneurysms, each >10 mm with a wide neck. We successfully performed Y-SAC in all cases on the first attempt using the \u201caround the world\u201d technique and used Neuroform Atlas Stent (Stryker Neurovascular, California, USA) as a distal anchor to reduce the microcatheter loop. Immediate final digital subtraction angiography showed adequate occlusion of all aneurysms.<\/jats:p>\n<\/jats:sec>\n\nResults<\/jats:title>\nAll patients tolerated the procedure well and were discharged home on postoperative day (POD) 1 in all cases. The first patient required a second coiling at the aneurysm neck 6 months after initial treatment, with complete protection of the dome. The second patient\u2019s 6-month follow-up angiogram showed complete occlusion of the aneurysm with patency of all MCA branches. Unfortunately, the third patient failed to comply with dual antiplatelet therapy after discharge and developed stent thrombosis 3 months postprocedure and passed away.<\/jats:p>\n<\/jats:sec>\n\nConclusion<\/jats:title>\nY-SAC is a reasonable option for large, wide-neck, MCA bifurcation aneurysms in patients who are not fit for microsurgical clipping and\/or bypass surgery. Complex endovascular techniques, including aneurysm encircling and the \u201cAtlas Stent Anchor\u201d technique, may be necessary to complete the procedure successfully.<\/jats:p>\n<\/jats:sec>","DOI":"10.25259\/sni_877_2024","type":"journal-article","created":{"date-parts":[[2025,2,28]],"date-time":"2025-02-28T07:51:17Z","timestamp":1740729077000},"page":"71","update-policy":"https:\/\/doi.org\/10.25259\/crossmark_policy","source":"Crossref","is-referenced-by-count":2,"title":["Y-stent-assisted coiling for large wide-neck dysplastic middle cerebral artery bifurcation aneurysm: An update to procedural technique"],"prefix":"10.25259","volume":"16","author":[{"given":"Anqi","family":"Luo","sequence":"first","affiliation":[{"name":"Department of Neurosurgery, UT Health San Antonio, San Antonio, Texas, United States"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Justin","family":"Mascitelli","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, UT Health San Antonio, San Antonio, Texas, United States"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Lee","family":"Birnbaum","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, UT Health San Antonio, San Antonio, Texas, United States"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Nohra","family":"Chalouhi","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, University of Florida, Gainesville, Florida, United States"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Fadi","family":"Al Saiegh","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, UT Health San Antonio, San Antonio, Texas, United States"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"10894","published-online":{"date-parts":[[2025,2,28]]},"reference":[{"key":"10.25259\/SNI_877_2024\/ref-1","doi-asserted-by":"crossref","first-page":"827","DOI":"10.1227\/neu.0000000000002283","article-title":"The angiographic and clinical follow-up outcomes of the wide-necked and complex intracranial aneurysms treated with LVIS EVO-assisted coiling","volume":"92","author":"Aydin","year":"2023","journal-title":"Neurosurgery"},{"key":"10.25259\/SNI_877_2024\/ref-2","doi-asserted-by":"crossref","first-page":"1987","DOI":"10.3174\/ajnr.A3538","article-title":"Stent-assisted coiling versus balloon remodeling of wide-neck aneurysms: Comparison of angiographic outcomes","volume":"34","author":"Chalouhi","year":"2013","journal-title":"AJNR Am J Neuroradiol"},{"key":"10.25259\/SNI_877_2024\/ref-3","first-page":"509","article-title":"A novel endovascular treatment of a wide-necked basilar apex aneurysm by using a Y-configuration, double-stent technique","volume":"25","author":"Chow","year":"2004","journal-title":"AJNR Am J Neuroradiol"},{"key":"10.25259\/SNI_877_2024\/ref-4","doi-asserted-by":"crossref","first-page":"441","DOI":"10.1016\/j.surneu.2006.11.056","article-title":"Microneurosurgical management of middle cerebral artery bifurcation aneurysms","volume":"67","author":"Dashti","year":"2007","journal-title":"Surg Neurol"},{"key":"10.25259\/SNI_877_2024\/ref-5","doi-asserted-by":"crossref","first-page":"6","DOI":"10.1227\/01.NEU.0000097194.35781.EA","article-title":"Preliminary experience using the Neuroform stent for the treatment of cerebral aneurysms","volume":"54","author":"Fiorella","year":"2004","journal-title":"Neurosurgery"},{"key":"10.25259\/SNI_877_2024\/ref-6","doi-asserted-by":"crossref","first-page":"102","DOI":"10.1093\/neuros\/nyab090","article-title":"Neuroform atlas stent for treatment of middle cerebral artery aneurysms: 1-year outcomes from neuroform atlas stent pivotal trial","volume":"89","author":"Hanel","year":"2021","journal-title":"Neurosurgery"},{"key":"10.25259\/SNI_877_2024\/ref-7","doi-asserted-by":"crossref","first-page":"944","DOI":"10.3171\/jns.1997.87.6.0944","article-title":"Intravascular stent and endovascular coil placement for a ruptured fusiform aneurysm of the basilar artery. 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