Comparative Effectiveness of Surgical, Endovascular, and Conservative Strategies for Unruptured Intracranial Aneurysms

Endovascular coiling appears to offer the best short- to intermediate-term outcomes, whereas microsurgical clipping provides more durable long-term protection despite greater procedural risks. Conservative observation remains the least favorable strategy and may be reserved for highly selected low-risk patients. Further large-scale trials are needed, particularly in posterior circulation aneurysms and for patient-centered outcomes such as quality of life and cognition.