The article reviews the current trends and future directions in the management of intracranial aneurysms (IA). It discusses the evolution of treatment strategies, including surgical clipping, endovascular coiling, and newer devices such as flow diverters and intrasaccular flow disruptors. IA are focal dilations of cerebral arteries, often asymptomatic but can rupture, causing subarachnoid hemorrhage (SAH), a catastrophic event with high mortality and morbidity. Over the past three decades, treatment approaches have evolved significantly, with endovascular therapy becoming the mainstay for ruptured IA due to robust clinical evidence. For unruptured IA, treatment is increasingly indicated to prevent rupture, with both surgical and endovascular options available. Surgical clipping remains effective for certain cases, while endovascular techniques, such as coiling, balloon-assisted coiling, stent-assisted coiling, and flow diverting stents, have improved outcomes. Flow diverters, which redirect blood flow away from the aneurysm, have shown high occlusion rates and are effective for complex aneurysms. Newer devices, such as the Woven EndoBridge (WEB), pCONus, PulseRider, and eCLIPs, offer improved options for treating bifurcation and other complex aneurysms. These devices allow for better coverage, reduce the need for antiplatelet therapy, and improve outcomes. The article also highlights the role of artificial intelligence in future IA management, enhancing detection and treatment planning. Current evidence suggests that endovascular therapy is often preferred for certain aneurysms, particularly those with complex anatomy, while surgical clipping remains a viable option for others. Factors such as aneurysm size, location, and patient characteristics influence treatment selection. The availability of various devices and techniques has made endovascular therapy more accessible, but challenges remain, including the need for long-term follow-up and the risk of recanalization. Overall, the management of IA has evolved significantly, with a focus on improving safety, efficacy, and patient outcomes.The article reviews the current trends and future directions in the management of intracranial aneurysms (IA). It discusses the evolution of treatment strategies, including surgical clipping, endovascular coiling, and newer devices such as flow diverters and intrasaccular flow disruptors. IA are focal dilations of cerebral arteries, often asymptomatic but can rupture, causing subarachnoid hemorrhage (SAH), a catastrophic event with high mortality and morbidity. Over the past three decades, treatment approaches have evolved significantly, with endovascular therapy becoming the mainstay for ruptured IA due to robust clinical evidence. For unruptured IA, treatment is increasingly indicated to prevent rupture, with both surgical and endovascular options available. Surgical clipping remains effective for certain cases, while endovascular techniques, such as coiling, balloon-assisted coiling, stent-assisted coiling, and flow diverting stents, have improved outcomes. Flow diverters, which redirect blood flow away from the aneurysm, have shown high occlusion rates and are effective for complex aneurysms. Newer devices, such as the Woven EndoBridge (WEB), pCONus, PulseRider, and eCLIPs, offer improved options for treating bifurcation and other complex aneurysms. These devices allow for better coverage, reduce the need for antiplatelet therapy, and improve outcomes. The article also highlights the role of artificial intelligence in future IA management, enhancing detection and treatment planning. Current evidence suggests that endovascular therapy is often preferred for certain aneurysms, particularly those with complex anatomy, while surgical clipping remains a viable option for others. Factors such as aneurysm size, location, and patient characteristics influence treatment selection. The availability of various devices and techniques has made endovascular therapy more accessible, but challenges remain, including the need for long-term follow-up and the risk of recanalization. Overall, the management of IA has evolved significantly, with a focus on improving safety, efficacy, and patient outcomes.