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Introduction/Purpose Aneurysms can be treated with a number of endovascular modalities. Two treatments popular for wide necked and complex aneurysms are intrasaccular flow disruption (IFD) and coiling with the assistance of stent or balloon. While both modalities are safe and efficacious, direct comparison data regarding neurologic safety is limited.Material and Methods The NeuroVascular Quality Initiative Quality Outcomes Database (NVQI-QOD) Cerebral Aneurysm Registry was queried for treatments of unruptured aneurysms using either IFD or coil-adjunct (balloon or stent-assisted) embolization. Aneurysms from patients with poor pre-treatment modified Rankin Score (mRS) >1 were excluded. Propensity score matching (PSM) between the IFD and adjunct coil embolization cohorts was done based on patient age and aneurysm characteristics (location, size, and dome-to-neck ratio). Locations examined included the carotid terminus, middle cerebral artery bifurcation, basilar artery, and anterior communicating artery. Immediate neurologic decline was the primary endpoint, as defined by a discharge mRS of greater than 2. Secondary endpoints included noted perioperative complication and radiographic obliteration.Results Of all eligible cases, 127 treatments with IFDs and 253 coil-adjunct treatments were identified. After PSM, 127 IFD and 127 coil-adjunct cases were analyzed. The mean age at treatment was 64 ±10 years, and 69% (174/254) of patients were female. The mean aneurysm size was 6.8 ±2.7 mm, the average dome-to-neck ratio was 1.8 ±1.2. The rate of poor discharge mRS (>2) was 4.7% (6/127) for IFD and 3.1% (4/127) for coil-adjunct embolization (p=0.52). There were not any significant differences between IFD and coil-adjunct embolization regarding intraoperative complication rate (4.7% and 9.4%, p=0.14) and postoperative complication rate (4.7% and 7.9%, p=0.30). Coil-adjunct treatment had a higher rate of radiographic obliteration at treatment completion (51% vs 44%, p<0.001).Conclusion For the treatment of unruptured aneurysms, the complication rates and incidence of immediate neurological decline is similar between IFD and coil-adjunct embolization. Coil-adjunct embolization had a higher rate of complete aneurysm occlusion.Disclosures C. Fritch: None. S. Shah: None. E. Church: None. S. Simon: None. K. Cockroft: None. D. Wilkinson: None.