Introduction Device developments and evolution in technique over the past decade make the treatment of aneurysms which were previously considered poor candidates for coiling more feasible. The authors describe their experience treating aneurysms at a single high-volume tertiary care center, focusing particularly on the use of adjunctive devices.

Methods A retrospective review was undertaken of all the aneurysms treated at the Cleveland Clinic between 2003 and 2010.

Results A total of 1455 aneurysms were treated (45% subarachnoid hemorrhage). In 2003, aneurysms were treated equally with clipping (49.6%) and coiling (50.4%). Over the 8-year period reviewed there was a decline in the percentage of aneurysms treated surgically. By 2010, 25.5% of aneurysms were treated surgically and 74.5% by endovascular coiling. Among aneurysms that were coiled there was an increase in the cases treated with adjuncts including balloon remodeling and stents. The most dramatic increase in the relative proportion of a single method was the more widespread use of the combined ‘balloon stent’ technique. Initially used in 12% of stent-assisted cases, it is currently employed in 35.4% of cases.

Conclusions Significant changes in practice trends for aneurysm treatment have been observed at a single high-volume tertiary care center over the past decade. Although these changes are multifactorial, they are explained in part by institutional comfort level with the adoption of adjunctive techniques, with a growing number of aneurysms treated with balloon remodeling and the ‘balloon stent’ technique.