Abstract： Objective To evaluate the risk, difficulty and indication of clipping and coiling for anterior communicating artery aneurysms (AcomA). Method 186 patients with AcomA were treated. We chose the treatments options according the risk and difficulty. Fifty-eight cases were treated with clipping through pterional approach,8 through orbitocranial approach and 120 with coil embolization. Results Of the 66 patients with clipping,2 were left with procedure-related hemiparalysis and 3 died. Of the 120 patients with coil cmbolization, 2 were left with procedure-related neurological deficits, 3 died and 1 rebleeding. Conclusions There is different risk and difficulty in different cases with different therapy. The evaluation of the risk is important basis for decision of treatment option.