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Introduction Studies on stent-assisted coil embolization (SAC) for ruptured aneurysms have yielded varied results, with no definitive conclusions regarding its safety and efficacy.Aim of study This study reports the outcomes of treatments performed at our institution to evaluate the safety and efficacy of SAC.Method We retrospectively analyzed patients who underwent SAC for ruptured aneurysms between 2019 and 2023. A total of 73 patients were included in the study, with 30 undergoing SAC and 43 treated with non-stent coiling (NSC).Results Thromboembolic events occurred in 5 patients (16.7%) in the SAC group, a significant difference compared to none in the NSC group (p = 0.009). However, there was no statistically significant difference in the rates of symptomatic infarction or radiologic infarction between the groups (13.3% vs. 0%, p = 0.073; and 40.0% vs. 55.8%, p = 0.330, respectively). EVD-related hemorrhages were significantly more common in the SAC group (4/5 [80.0%] vs. 0/8 [0%], p = 0.007), but these were minor and asymptomatic. Immediate postoperative outcomes and results after more than six months of follow-up showed no significant differences between the groups.Conclusion SAC may carry a higher risk of thromboembolic events in ruptured aneurysm cases. However, with adequate preparation, including the use of DAPT and IA tirofiban injections to prevent and manage thrombus formation, the procedure can be performed safely. While this study did not demonstrate a significant difference in recanalization rates or fully establish its efficacy, SAC can still be proposed as a potential treatment option for ruptured aneurysms.Conflict of Interest No