Salem MM, Maragkos GA, Gomez‐Paz S, et al. - A paradigm shift has been generated by the ISAT (International Subarachnoid Aneurysm Trial) towards endovascular treatment for intracranial aneurysms. Researchers here examined the correlation between the treatment burden of unruptured and ruptured aneurysms in the post‐ISAT era. Admissions data of patients with a primary diagnosis of aneurysmal subarachnoid hemorrhage (aSAH) or unruptured intracranial aneurysms treated by clipping or coiling were extracted from the National Inpatient Sample (2004–2014). Within each year, they randomly matched this combined group to a non‐aneurysmal control group, based on age, gender, and Elixhauser comorbidity index. They identified a total of 243,754 patients with aneurysm after adjusting for National Inpatient Sample sampling effects. Of these, 121 882 (50.01%) patients underwent treatment for unruptured aneurysms, 79,627 (65.3%) endovascularly and 42,256 (34.7%) surgically. Procedures for aSAH were performed on a total of 121,872 (49.99%) patients, 68,921 (56.6%) endovascular, and 52,951 (43.5%) surgically. Analysis revealed a significant reduction in relative risk ratio of undergoing treatment for aSAH with each passing year, this was concomitant with a stable annual risk of undergoing treatment for unruptured intracranial aneurysms.