We report our preliminary experience using radial artery graft bypass in patients with ruptured internal carotid artery aneurysm. The following types of 12 ruptured internal carotid artery aneurysms were treated: dorsomedial aneurysms with ill-defined necks (in 8 patients); tiny paraclinoid aneurysms projected in the superior (n=1) and ventral (n=1) direction; fusiform aneurysm (n=1) located between the C1 segment and M1 segment; and an IC-PC aneurysm (n=1) previously clipped 15 years before. Bypass procedures employed were EC-radial artery-M2 bypass in 6, and temporary using RA-M2 bypass (i.e., forearm vascular pedicle) in 6. Complete obliteration of aneurysms with no ischemic complication was achieved in all dorsomedial internal carotid aneurysms. Graft failure occurred in 1 case. Our experience emphasizes the importance of achieving vascular anastomosis in various clinical settings. We also describe a proposed strategy to obliterate blister aneurysm.