• International study to compare neurosurgical clipping versus endovascular coiling for ruptured intracranial aneurysms.
• Multi-center, randomized, controlled trial.
• Patients with subarachnoid hemorrhage due to ruptured aneurysms who were deemed suitable for either treatment were included. 
• Outcome measures: Primary outcomes were death or dependence at 1 year (modified Rankin scale of 3-6). Secondary outcomes were rebleeding, and risk of seizures.
• Endovascular coiling group: 1073 patients, 1063 included in 1-year analysis, 23.5% dead or dependent. 
• Neurosurgical clipping group: 1070 patients, 1055 included in 1-year analysis, 30.9% dead or dependent. 
• Survival benefit for coiling was maintained for at least 7 years and was statistically significant (p=0.03).
• Risk of seizures was significantly lower in the coiling group [RR=0.52, CI:0.37-0.74].
• Risk of late rebleeding is low, but was found to be more common after coiling than after clipping.

Reference:

Lancet

https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(05)67214-5/fulltext