Primary outcomes included death or dependent living, and secondary outcomes included risk of seizures and risk of rebleeding. Initial 1-year outcomes revealed a reduction in death and disability from 31% in the microsurgery arm to 24% in the endovascular arm (relative risk reduction, 24%).141 This difference was mainly driven by a decrease in the rate of disability among survivors 16% in the endovascular arm and 22% in the craniotomy arm) and was likely attributable at least in part to the greater incidence of technical complications in the clipping (19%) versus the coiling (8%) arms and the longer time needed to secure the aneurysm.142,143 The risk of epilepsy and signifi- cant cognitive decline was also reduced in the endovascular group, but the incidence of late rebleeding (2.9% after endovascular repair versus 0.9% after open surgery) was higher in the endovascular arm, and only 58% of coiled aneurysms were completely obliterated compared with 81% of clipped aneurysms.140 A large retrospective analysis found that the rate of incomplete occlusion and subsequent aneu- rysm recurrence depended critically on neck diameter and dome size.139 It can also be difficult to achieve complete obliteration in very small aneurysms ( 3 mm), with 1 study reporting no coils deployed in 5% of cases, residual dome filling or a neck remnant in 30%, and a higher procedural complication rate than in larger aneurysms.144 Although the complete obliteration rate can be increased by the addition of a high-porosity stent, this has been associated with an increased risk of complications, especially in patients with SAH, in large part because of the need for periprocedural dual-antiplatelet therapy to prevent arterial thromboembolism.145 Whether low-porosity flow-diverting stents with or without coils represent a better option for many or most of those presenting with SAH from saccular aneu- rysms remains to be studied, but these stents make more conceptual sense for use in the patient with a dissecting aneurysm, in whom vessel sacrifice is not an option and microsurgical solutions carry higher risk. 