AIM: To discuss the features, feasibility, and safety of a combined bilateral approach in the endovascular treatment of intracranial anterior communicating artery (ACoA) aneurysm.

MATERIAL and METHODS: We performed a retrospective analysis of the clinical data of patients with ACoA aneurysm treated with a combined bilateral approach.

RESULTS: We successfully embolized aneurysms in nine patients with intracranial ACoA aneurysm using a combined bilateral approach. All treated patients had an open ACoA connecting with the bilateral anterior cerebral arteries.

CONCLUSION: Because the ACoA connects the intracranial arteries in both hemispheres, patients with ACoA aneurysm can be endovascularly treated with a combined bilateral approach. Notably, surgeon experience and dexterity play important roles in the success of this procedure.