Objective To explore the influencing risk factors of perioperative technical complications and clinical prognosis of stent-assisted coiling (SAC) for acute (≤ 28 d) ruptured intracranial aneurysm (RIA). Methods Acute RIA patients, who received SAC treatment in Changhai Hospital of Naval Medical University (Second Military Medical University) between Jan. 2012 and Jun. 2018, were retrospectively enrolled. The clinical and imaging data were analyzed using univariable analysis and multivariate logistic regression analysis to identify the potential risk factors of perioperative technical complications and clinical prognosis. Results A total of 509 acute RIA patients (170 males and 339 females), who underwent SAC treatment and received 30-d follow-up, were included in this study. Perioperative ischemic complications occurred in 28 cases (5.5%), and multivariate regression analysis showed that the location of aneurysms at the bifurcation of blood vessels was an independent risk factor of ischemic complications (odds ratio[OR]=4.108, P=0.001). Perioperative hemorrhagic complications occurred in 25 cases (4.9%), and multivariate regression analysis showed that age<60 years was an independent risk factor of hemorrhagic complications (OR=3.574, P=0.014). The modified Rankin scale (mRS) scores of 81 patients (15.9%) ranged from 3 to 5 at discharge, 27 patients (5.3%) died with mRS score of 6, and the poor prognosis (mRS score>2) rate was 21.2% (108/509). Multivariate regression analysis showed that age ≥ 80 years, Hunt-Hess 3-5 class, perioperative ischemic complications, perioperative hemorrhagic complications and poor Glasgow coma scale (GCS) score were independent risk factors of poor prognosis (all P<0.01). Conclusion For the acute RIA patients treated with SAC, the location of aneurysms at the vascular bifurcation is an independent risk factor of perioperative ischemic complications; age<60 years is an independent risk factor for hemorrhagic complications; and the patients with poor GCS score at admission have a poor prognosis at discharge, and perioperative ischemic and hemorrhagic complications are independent risk factors of poor prognosis.