Time-of-flight magnetic resonance angiography is a non-invasive alternative to digital subtraction angiography (DSA) for follow up of coiled intracranial aneurysms. Standard cranial MRA protocols are a compromise between spatial resolution and imaging time. This study compares a standard resolution MRA protocol with a protocol at higher spatial resolution MRA (HR-MRA) in 21 follow-up occasions in 17 coiled aneurysms in 15 patients. Images were reviewed for presence of residual or recurrent aneurysm and compared with DSA as the gold standard. Aneurysm flow signal on standard resolution MRA differed significantly from HR-MRA in 6/21 cases (P = 0.02) and DSA in 6/21 cases (P = 0.02). HR-MRA had 100% concordance with DSA (P = 1.0). In this study, three-dimensional time-of-flight magnetic resonance angiography carried out at standard resolution is inadequate for follow up of coiled intracranial aneurysms. HR-MRA is comparable to DSA for detection of aneurysm recurrence.