Which is more effective for ruptured intracranial aneurysms suitable for either modality: surgical clipping or endovascular coiling? The ISAT trial was a landmark randomized controlled trial comparing neurosurgical clipping with endovascular coiling for the treatment of ruptured intracranial aneurysms. The study enrolled 2143 patients and demonstrated that patients treated with endovascular coiling had a significantly lower rate of death or dependence at 1 year compared to those treated with surgical clipping. The findings indicated that endovascular coiling was associated with better outcomes in terms of functional recovery and reduced complications, leading to a shift in clinical practice towards preferring coiling over clipping for most patients with ruptured intracranial aneurysms.