OBJECTIVE We aimed to compare the efficacy of microsurgical clipping of intracranial aneurysms with that of arterial embolization in the treatment of ruptured anterior circulation aneurysms. METHODS The clinical data of 68 patients treated in our hospital for ruptured anterior circulation aneurysms between January 2017 and March 2020 were analyzed retrospectively. According to the surgical methods, the patients were divided into two groups: the microsurgical clipping group (30 cases) and the arterial embolization group (38 cases). The following markers were compared between the two groups: Hunt-Hess classification (HHC) grading, aneurysm occlusion rate, and incidence of postoperative complications, length of hospital stay, hospitalization cost, and the scores of the Glasgow Outcome Scale, Modified Rankin Scale, and Barthel Index during the 6-months follow-up after hospital discharge. RESULTS The cases of HHC grade I and II increased in both groups at hospital discharge (both P<0.05), and there was no intergroup difference in this marker (P>0.05). The complete occlusion rate in the microsurgical clipping group was higher than that in the arterial embolization group (P<0.05). Compared with the microsurgical clipping group, the arterial embolization group had shorter length of hospital stay and higher hospitalization cost (both P<0.05). There was no difference in the total incidence of postoperative complications between the two groups (P>0.05). However, the arterial embolization group had lower incidence of intracranial infection and higher incidence of vasospasm than the microsurgical clipping group (both P<0.05). During the follow-up, the arterial embolization group had better results in terms of the Modified Rankin Scale and Barthel Index results and had more patients with GOS score of 5 points than the microsurgical clipping group (all P<0.05). CONCLUSIONS Both microsurgical clipping of intracranial aneurysms and arterial embolization can effectively treat ruptured anterior circulation aneurysms, and the short-term efficacy achieved by these two methods is similar. Compared with microsurgical clipping of intracranial aneurysms, arterial embolization can lead to shorter hospitalization, lower incidence of intracranial infection, and better patients' prognosis and quality of life after the operation. However, the microsurgical clipping of intracranial aneurysms can achieve higher complete occlusion rate, lower incidence of vasospasm, and lower hospitalization cost than arterial embolization.