Abstract: Objective To evaluate the clinical effect of ultra-early endovascular treatment of ruptured tiny intracranial aneurysms(RTIAs).Methods A total of 35 patients with RTIAs who were treated with endovascular embolization within 24 hours after subarachnoid hemorrhage in our department from May 2017 to November 2022 were retrospectively analyzed.The basic clinical information, endovascular treatment results, clinical and imaging follow-up results were analyzed.Results The mean aneurysms maximum diameter is was (2.5±0.4)mm.Of these 35 patients with RTIAs，23 patients(65.7%) were treated with simple coil embolization，12 patients(34.3%) with stent assisted coiling.Immediate angiographic results showed that Raymond gradeⅠin 20 patients(57.1%)，Ⅱ in 13(37.2%)，Ⅲ in 2(5.7%).Perioperative complications occurred in 4 patients(11.4%)，including Intraoperative aneurysm rupture in 2(5.7%)，intra-stent thrombosis in 2(5.7%)，massive cerebral infarction followed by decompressive craniectomy in 1，postoperative death in 1.Angiographic follow-up was performed in 24 patients(68.6%)，recurrence in 1 patient receiving retreatment.Clinical follow-up were performed in 33 patients，The mRS of 0-2 were in 31 patients(93.9%).Conclusion Ultra-early endovascular treatment of RTIAs is effective and relatively safe,with favorable angiographic results and clinical outcomes at follow up.Intraoperative aneurysm rupture and thrombosis are the major perioperative complications.

Key words: intracranial aneurysm； tiny； rupture； endovascular treatment； ultra-early stage