OBJECTIVE: To compare the safety, efficacy, and prognosis of stent-assisted coiling (SAC) versus coiling alone (CA) in the treatment of ruptured anterior communicating artery aneurysms (ACoAAs). METHODS: The clinical and follow-up data of ruptured ACoAAs treated with endovascular treatment in our center from January 2011 to January 2021 were retrospectively collected. Patients were divided into an SAC group and a CA group based on whether stents were used, after which the two groups were matched for propensity scores. The general clinical data, embolization effect, perioperative complications, clinical, and follow-up results after matching were compared. RESULTS: A total of 354 patients were enrolled, of whom 147 patients (41.5%) received SAC and the rest received CA. Comparison baseline of two groups showed that patients with a larger diameter, wide neck, irregular morphology, and anterior direction were more likely to receive SAC. After propensity score matching, 113 patients were included in each group. Immediately postoperative angiography results showed that the complete embolization rate of patients in the SAC group was significantly lower than that in the CA group (62.8% vs. 76.1%, p = 0.03). There were no significant differences between the two groups in the incidence of perioperative complications, mortality, poor prognosis at discharge or follow-up, mid-term complete occlusion rate and recurrence rate. CONCLUSION: The stent-assisted treatment of ruptured ACoAAs did not increase the risk of perioperative complications or the probability of poor prognosis, indicating that SAC treatment of ruptured ACoAAs is safe and feasible and has a reliable mid-term cure rate.