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Introduction Advancements in endovascular treatments have increased the number of interventions for ruptured intracranial aneurysms (RIAs) in South Korea, while the use of surgical clipping has declined.Aim of study This study examined one-year mortality outcomes for RIA patients who underwent clipping or coiling in 2018, using National Health Insurance Service data.Method Coiling was classified as non-stent assisted (NSAC) or stent assisted (SAC). Hospitals were grouped into tertiary referral general hospitals (TRGHs), general hospitals (GHs), and semi-general hospitals (sGHs), with analysis across 15 regions.Results Among hospitals performing over 20 procedures, no significant difference in one-year mortality was found between clipping and overall coiling. However, SAC was associated with significantly higher mortality compared to NSAC and clipping. While hospital size had little impact on coiling outcomes, TRGHs showed significantly lower mortality for clipping than GHs. Additionally, higher clipping volume at TRGHs correlated with reduced mortality.Abstract A281 Table 1Treatment outcomes at hospitals that performed more than 20 ruptured intracranial aneurysms treatments according to treatment modalityAbstract A281 Table 2Treatment outcomes at hospitals that performed more than 20 ruptured intracranial aneurysms treatments according to hospital sizeConclusion These findings suggest that while coiling outcomes are consistent across hospital sizes, outcomes for clipping vary based on hospital type and volume. The higher mortality associated with SAC highlights the need for careful patient selection. National efforts to standardize and improve clipping practices, especially in high-volume centers, may enhance patient outcomes.Conflict of Interest No