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The long-term complications of coil treatment of giant intracranial aneurysms were assessed in 334 instances when treatment consisted of only coiling (225), stent-assisted coiling (88), parent vessel occlusion (14), or balloon-assisted coiling (7). The authors concluded that coiling of large and giant aneurysms has reasonable safety profiles with good clinical outcomes, but aneurysm reopening was common. Stent-assisted coiling had lower recurrence, retreatment, and new or recurrent hemorrhage rates with no additional morbidity compared with conventional coiling. Aneurysm size was a major determinant of recanalization, retreatment, new or recurrent hemorrhage, and poor outcome.