[Treatment Choice for Ruptured Intracranial Aneurysm in the Hybrid Era]

Long-term follow-up results from the International Subarachnoid Aneurysm Trial suggest that coiling is preferable for ruptured aneurysms treatable with both modalities. This finding has led to a growing trend towards coiling for these patients. At our institute, coiling is now the first-line treatment for ruptured aneurysms, with exceptions for middle cerebral artery aneurysms. We also favor direct surgery for small ruptured aneurysms(<3 mm), cases with massive intracerebral hematoma, or situations requiring bypass surgery. While early rebleeding after coiling is uncommon, it carries a certain risk. Therefore, we sometimes choose clipping for ruptured anterior communicating artery or posterior communicating artery aneurysms if clipping poses minimal technical difficulty. To achieve optimal outcomes for ruptured aneurysms, a combined approach is crucial. This involves safe and effective endovascular treatment alongside necessary direct surgical interventions.