To establish and validate a risk prediction model for perioperative ischaemic complication (PIC) of endovascular treatment (EVT) for ruptured anterior communicating artery aneurysms (ACoAAs). The general clinical and morphological data, operation schemes, and treatment outcomes of patients with ruptured ACoAAs treated with EVT in our centre from January 2010 to January 2021 were retrospectively analysed and assigned to primary (359 patients) and validation (67 patients) cohorts. A risk-predicted nomogram for PIC was developed through multivariate logistic regression analysis in the primary cohort. The discrimination ability, calibration accuracy and clinical utility of the established PIC prediction model were evaluated and verified based on the receiver operating characteristic curves, calibration curves and decision curve analysis in the primary and external validation cohorts, respectively. A total of 426 patients were included, 47 of whom had PIC. The multivariate logistic regression analysis demonstrated that hypertension, Fisher grade, A1 conformation, use of stent-assisted coiling (SAC), and aneurysm orientation were independent risk factors for PIC. Then we developed a simple and easy-to-use nomogram to predict PIC. This nomogram has a good diagnostic performance (area under the curve was 0.773, 95%CI:0.685-0.862) and calibration accuracy, then we further validated this nomogram by external validation cohort and demonstrated an excellent diagnostic performance and calibration accuracy. Besides, the decision curve analysis confirmed the clinical utility of the nomogram. A history of hypertension, high preoperative Fisher grade, complete A1 conformation, use of SAC, and aneurysm orientation (pointing upwards) are risk factors for PIC for ruptured ACoAAs. This novel nomogram might serve as a potential early warning sign of PIC for ruptured ACoAAs.