It is accepted that endovascular treatment for intracranial aneurysms < 2 cm in diameter is not an alternative option to surgical treatment anymore but has rather gained the place as the first therapeutic option. Still, the long-term efficacy of endovascular aneurysm treatment remains uncertain. This article discusses clinical significance, incidence, risk factors and current management of aneurysm recurrence after endovascular treatment of intracranial aneurysms based on own Hamburg data and review of the literature. It also attempts to address potential solutions and future avenues to improve long-term efficacy of endovascularly treated intracranial aneurysms.