Wide-Neck and Bifurcation Aneurysms: Balancing Open and Endovascular Therapies

Wide-neck aneurysms (WNA) often require advanced open surgical and endovascular techniques to achieve adequate aneurysm occlusion. Microsurgical treatment often requires advanced clip configurations. Occasionally, more complex open surgical techniques are required. Advancements in endovascular therapies (EVT) and devices have expanded endovascular treatment options for WNAs and have improved aneurysm occlusion rates compared with primary coiling. Certain EVT require dual antiplatelet therapy, limiting their use in the ruptured setting. Evidence suggests that microsurgical treatment should remain a consideration for treatment of ruptured WNAs, but perhaps with novel endovascular techniques and devices, EVT should be first-line treatment in the unruptured setting.