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Introduction Cerebral vessel perforation is a rare but serious complication during cerfebral endovascular procedures, with limited evidence guiding bail-out strategies. This study evaluated different techniques in a controlled experimental setting.Aim of study This study investigates the efficacy of selected bail-out interventions in a experimental model.Method Twelve 3D-printed anterior circulation models were submerged in a water tank simulating intracranial pressure and connected to a pulsatile glycerin-water flow. Perforations were created at the carotid-T apex or MCA bifurcation using three diameters (0.35 mm, 0.57 mm, 0.89 mm) in two anatomical variations (with or without AcomA). Studied bail-out techniques included distal placement of a 5F catheter, deployment of a 3×6 mm or 7×20 mm coil, balloon occlusion at the perforation site, and ICA occlusion. The primary endpoint was the time until 50 mL of fluid extravasated through the perforation.Results Balloon occlusion at the perforation site was significantly associated with reduced leakage across all models (p < 0.01). A significant correlation was found between larger perforation size and increased leakage (p < 0.01). No significant effects were observed for the use of a 5F catheter, coil deployment, or ICA occlusion (p > 0.05). The localization of the perforation showed no significant impact on leakage rates (p > 0.05).Conclusion Balloon occlusion at the site of vessel perforation significantly delayed fluid extravasation in all experimental models. Other interventions, including 5F catheter placement, coil deployment, and ICA occlusion, demonstrated minimal to no effect.Conflict of Interest No