Cerebral aneurysms occur in 1-6% of general population 1 and aneurysmal subarachnoid hemorrhage continues to be a major cause of morbidity and mortality despite advances in microsurgical and endovascular treatment strategies. 2 Although these technologies are becoming more available, studies have historically indicated a relationship between health outcomes and patient volumes after both surgical and endovascular repair of aneurysms 3-7 justifying critical review of the outcomes and complication rates, especially at the nonspecialized low-volume institutions. In this issue of Journal of Neuroimaging , Gordhan and colleagues 8 present their experience in endovascular treatment of cerebral aneurysms at a low-volume community hospital, specifically addressing its safety and efficacy. This is the first such evaluation from a US-based center complimenting previously published studies on good outcomes of aneurysm clipping at low-volume centers. 9,10 In Europe, there were two recent studies published on the subject. Lindekleiv and colleagues 11 have indicated acceptable outcomes of both microsurgical and endovascular aneurysm treatment at a low-volume institution. Last year, a multicenter study by Pierot and colleagues 12 demonstrated similar clinical and radiographic outcomes of endovascular treatments for unruptured intracranial aneurysms in low-volume versus high-volume hospitals.In this study, authors present outcome data from 56 consecutive patients with both ruptured and unruptured cerebral aneurysms treated with endovascular methods (72 interventions) at a single institution over an approximately 5-year period. Overall, 87.9% of the treated patients had a good immediate clinical outcome with modified Rankin scale (mRS) score of 0-1. All patients with unruptured aneurysms had uniformly excellent clinical outcome with mRS = 0. In the ruptured aneurysm group, 61.9% of the patients had a discharge mRS of 0-1. Long-term clinical outcome was not reported. Periprocedural mortality was 4.3% (3/72 interventions) of which 1.3% (1/72 interventions) was attributed to intraprocedural complications. Overall procedure-related morbidity was 6.9% (2.3% for unruptured and 18% for ruptured aneurysms). 72.1% aneurysms demonstrated complete occlusion at the end of the initial procedures. These results are either comparable or favorable to those reported previously from higher-volume institutions as well as the aforementioned European low-volume centers. It has to be noted that there was a greater proportion of unruptured aneurysms in this series (65.6%) compared with larger studies while the patients were actually older (mean age = 61.7 years).