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The direct carotid exposure approach (DCEA) is a technical option for elderly patients with severe vessel tortuosity due to arteriosclerosis. We evaluated complications related to antiplatelet/anticoagulant management and compared the DCEA to standard transfemoral/transbrachial approaches (TFBA) in the treatment of unruptured intracranial aneurysms for elderly patients. From August 2017 to August 2020, 52 patients (53 procedures) aged over 75 years with unruptured aneurysms in the anterior circulation were treated at our institution. All patients received d