Endovascular Evolution in Subarachnoid Hemorrhage Management: A Comprehensive Review of Transitions from Coiling to Contemporary Stent-Assisted Therapies

Aneurysmal subarachnoid hemorrhage (aSAH) remains a critical neurosurgical emergency characterized by high morbidity and mortality, demanding continuous refinement of endovascular techniques. This extensive review synthesizes current evidence on the paradigm shift from simple coil embolization to advanced stent-assisted interventions for intracranial aneurysm management. The discourse navigates through foundational principles of Guglielmi detachable coil occlusion, highlighting its established role in securing ruptured aneurysms while scrutinizing limitations in complex morphologies. Subsequently, the analysis progresses to the integration of intracranial stents—focusing on flow-diverting and intrasaccular devices—which have redefined therapeutic boundaries for wide-necked, fusiform, or previously untreatable lesions. Contemporary literature underscores nuanced considerations in peri-procedural antiplatelet regimens, hemodynamic management, and long-term angiographic outcomes. By examining recent multicenter trials and meta-analyses, this review elucidates evolving indications, safety profiles, and cost-efficacy dynamics, ultimately framing a sophisticated understanding of modern neurointerventional strategy. The synthesis aims to equip clinicians with evidence-based insights for tailored therapeutic decision-making in a rapidly advancing field.