Surgical clipping or endovascular coiling of the rup- tured aneurysm should be performed as early as feasible in the majority of patients to reduce the rate of rebleeding after aSAH (Class I; Level of Evidence B). 2. Complete obliteration of the aneurysm is recom- mended whenever possible (Class I; Level of Evi- dence B). 3. Determination of aneurysm treatment, as judged by both experienced cerebrovascular surgeons and en- dovascular specialists, should be a multidisciplinary decision based on characteristics of the patient and the aneurysm (Class I; Level of Evidence C). (Revised recommendation from previous guidelines) 4. For patients with ruptured aneurysms judged to be technically amenable to both endovascular coiling and neurosurgical clipping, endovascular coiling should be considered (Class I; Level of Evidence B). (Revised recommendation from previous guidelines) 5. In the absence of a compelling contraindication, patients who undergo coiling or clipping of a rup- tured aneurysm should have delayed follow-up vas- cular imaging (timing and modality to be individu- alized), and strong consideration should be given to retreatment, either by repeat coiling or microsurgi- cal clipping, if there is a clinically significant (eg, growing) remnant (Class I; Level of Evidence B). (New recommendation) 6. Microsurgical clipping may receive increased con- sideration in patients presenting with large (>50 mL) intraparenchymal hematomas and middle cere- bral artery aneurysms. Endovascular coiling may receive increased consideration in the elderly ( 70 years of age), in those presenting with poor-grade Connolly et al Management of Aneurysmal Subarachnoid Hemorrhage 1721 (World Federation of Neurological Surgeons classi- fication IV/V) aSAH, and in those with aneurysms of the basilar apex (Class IIb; Level of Evidence C). (New recommendation) 7. 