Introduction: Anterior communicating artery complex (ACoA) is the most frequent intracranial aneurysms (30%) and the most complex of the anterior circulation, due to variation of architecture, flow and many branches involved. This paper aims toestablish anatomical study and clinical manifestations, analyzing a series of cases of AcoA aneurysms. Methods: Articles in PubMed, Scientific Direct were reviewed using as key words, anatomy variations. In addition, AcoA features were analyzedbased on our series cases. Results: Most common anatomical variations found in the literature were: plexiform (30%), curling (33%), fenestration (21%), duplication (18%). Clinical features: Fasciobraquial hemiparesis, headache, personality changes,intellectual deficit, anxiety, fear, emotional disturbances, dizziness, agitation, hypokinesia, decreased level of consciousness. Total of 5-year series of 234 cerebral aneurysms (32 deaths -13.6 %). Analyzing the series, 41 ACoA (18%), with 32 ruptured (78%); 19 deaths (46%); 16 prior hypertension arterial (39%); and a ratio between women and men of 2.25 were found. Conclusion: In our series, we concluded that the ACoA aneurysms are more common in women, the diagnosis is often after rupture and highincidence of death. Probably the anatomical variations, location between bifurcation arteries, A1 characteristics and different direction of the domus, contribute for different outcomes and uncertain clinics. Therefore, to predict the topography of theaneurysm by analyzing only the clinic is difficult.