In this communication, we studied whether 3D-CT angiography (3D CTA) gives us enough information for a safe operation without those from conventional catheter angiography (CCA) in patients with ruptured aneurysms. Between December 1996 and September 2005, we treated 162 consecutive patients with ruptured aneurysms in the acute stage based on 3D-CTA findings. One hundred sixty-two ruptured aneurysms, including 64 associated unruptured aneurysms, were detected using 3D-CTA. CCA was performed in nine (5.6%) of the 162 patients after 3D-CTA. They were four dissecting vertebral artery aneurysms, two basilar tip aneurysms, one basilar artery-superior cerebellar artery (BA-SCA), one previously clipped BA-SCA and one internal carotid-posterior communicating artery aneurysm. All ruptured aneurysms confirmed at surgery were treated successfully. The lack of information on CCA did not lead any neurological deficits or difficulties in the surgical procedure. 3D-CTA was of high diagnostic value compatible with CCA and yielded important information such as the configuration of the aneurysmal sac and neck, calcification in the aneurysmal wall, and the aneurysms' anatomic relation with adjacent vessels and bone structures. We suggest that 3D-CTA can replace CCA in the diagnosis of ruptured aneurysms and that most of ruptured aneurysms can be operated by using only 3D-CTA without CCA.