Objective To summarize the key points of perioperative anesthetic management for patients with intraoperative aneurysm rupture during interventional intracranial aneurysm embolization. Methods Patients who underwent intracranial aneurysm embolization in Beijing Tiantan Hospital, Capital Medical University from January 1, 2019 to July 10, 2023 were enrolled and their medical data were retrospectively analyzed. Their demographic, perioperative and postoperative information was collected. Results Intraoperative aneurysm rupture occurred in nine patients. Their average basal blood pressure was 150 mmHg/80 mmHg (minimum 140 mmHg/70 mmHg and maximum 160 mmHg/90 mmHg, 1 mmHg=0.133 kPa). After aneurysm rupture, the average blood pressure was 200 mmHg/100 mmHg (minimum 160 mmHg/90 mmHg and maximum 220 mmHg/100 mmHg), and the variation coefficient of systolic blood pressure was 20.2% (5.2%, 26.5%). After aneurysm rupture, three patients had their blood pressure controlled at the anesthesia maintenance level within 10 minutes, while the other six patients had their blood pressure controlled at the anesthesia maintenance level within 20 min or more. Three patients were conscious enough to remove the laryngeal mask and left the operating room, while six patients left the room with the endotracheal tube. Six patients recovered and discharged, one patient died after being transferred to another hospital, and two patients died in the hospital. Conclusions The risk of death for patients with ruptured aneurysm during intracranial aneurysm embolization is as high as 33.3%. Anesthesiologists should raise awareness, conduct a detailed preoperative assessment of the patient's cardiovascular condition, and perform comprehensive circulatory monitoring during surgery. During the rescue process, early control of blood pressure, maintenance of circulatory stability and reduction of blood loss are the top priorities of anesthesia management.