Aim:Wide-necked anterior communicating artery (Acoma) aneurysms are difficult to treat by either clipping or by endovascular therapy (EVT). To the best of our knowledge, this is the first study to compare the outcome of ruptured wide-necked Acoma aneurysms treated by clipping or EVT by a dual-trained neurovascular neurosurgeon.Material and Methods:Among 130 patients with ruptured Acoma aneurysms with neck size of ≥4 mm treated between July 2018 and December 2021, 60 patients with wide-necked Acoma aneurysms were enrolled in this study. They were divided into group 1, comprising those who underwent treatment with clipping (n = 34), and group 2, comprising those who underwent treatment with EVT (n = 26).Results:The average neck diameters of the EVT and clipping groups were 4.15 ± 1.11 and 6.66 ± 2.27 mm, respectively. Perioperative aneurysm rupture was found in five and two patients in the clipping and EVT groups, respectively (p = 0.13). Good Glasgow Outcome Scale score at follow-up was observed in 84% and 79% of patients in the EVT and clipping groups, respectively (p = 0.02). Raymond–Roy occlusion grade 1 was achieved in 84% and 90.6% of the patients in the clipping and EVT groups, respectively (p = 0.483). The length of stay in the intensive care unit (ICU) (p = 0.001) and hospital (p = 0.001) was shorter in the EVT group.Conclusion:The clinical outcome of patients with ruptured wide-necked Acoma aneurysm may be better in the EVT group than in the clipping group, with the procedures performed by a neurosurgeon with dual training in microsurgical clipping and EVT. Such training may help in ensuring timely intervention to minimize perioperative complications, such as rebleeding, vasospasm, infarction, and hydrocephalus, thereby reducing the length of ICU stay and making the treatment cost-effective in resource-starved patient populations.