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Introduction Management of ruptured cerebral aneurysms has evolved considerably, with endovascular coiling becoming the standard of care in many centres. While randomised controlled trials (RCTs), such as the International Subarachnoid Aneurysm Trial (ISAT), have established the efficacy of coiling, their findings may not fully reflect real-world populations—particularly elderly or comorbid patients with poor neurological grades. 1–3 Aim of study To evaluate outcomes following endovascular coiling of ruptured cerebral aneurysms in a real-world population and describe the clinical and angiographic characteristics of treated patients.Method We conducted a retrospective study of patients who underwent simple or balloon-assisted coiling for ruptured cerebral aneurysms between January 2020 and November 2024 at a single UK centre. Data included demographics, World Federation of Neurological Surgeons (WFNS) admission grades, procedural details, complications, and angiographic outcomes classified using the Raymond-Roy Occlusion Classification (RROC).Abstract A260 Table 1Comparison of population demographics and WFNS admission grades in our study vs ISATResults 301 patients with 318 ruptured aneurysms were treated using simple (n=247) or balloon-assisted (n=71) coiling. At admission, 9.0% were WFNS grade IV-V and 23.3% were intubated ( table 1). The in-hospital mortality rate was 10.6%. Vasospasm occurred in 29.2%, and cerebral infarction in 23.3%. Follow-up imaging (n=235) showed RROC I in 59.1%, RROC II in 37.4%, and RROC III in 3.4%. Retreatment was required in 7.2%, and post-procedural rebleeding occurred in 1.7%. Key outcomes, including discharge Modified Rankin Scale (mRS) score, are summarised in table 2.Abstract A260 Table 2Comparison of key outcomes in our study (post-procedural mRS and mortality rate at discharge) vs ISAT (post-procedural mRS and mortality rate at 2 month follow up)Conclusion Despite a high proportion of elderly and poor-grade patients, clinical and radiological outcomes were comparable to RCT data, suggesting that technological advances and operator experience might have contributed to improved outcomes in higher-risk cohorts. 1–3 Conflict of Interest No