Objective To investigate effective prevention and treatment of ischemic brain injury（ IBI） after ruptured aneurysm clipping. Methods By retrospectively analyzing 389 cases of ruptured aneurysm clipping patients’ clinical and image data， who were admitted to our ward from 2014 to 2017， it explored the specific causes and prevention methods of postoperative cerebral ischemic injury. Results There were 27 patients suffered IBI among 389 cases of ruptured aneurysm clipping， with the incidence rate 6.9%， and there were 12 cases of early IBI and 15 cases of late IBI. The main reasons for IBI were the damage of perforating branches， cerebral vasospasm， temporary vascular occlusion， watershed infarction and cerebral thrombosis. Early IBI was mainly caused by the damage of perforating branches， while late IBI was mainly caused by the cerebral vasospasm. Conclusions Combination with application of Doppler ultrasonography，neuroendoscopy， neurophysiological monitoring（ NEPM） can effectively decrease the damage of perforating branches， the ischemic brain damage caused by parent artery stenosis and temporary vascular occlusion. It is also suggested in the research that reducing excessive handling on vessels， removing the hematoma and subarachnoid hemorrhage and discharge the hemorrhagic cerebrospinal fluid by lumbar subarachnoid catheter can effectively prevent cerebral vasospasm. 3H treatment can significantly reduce ischemic brain damage brought by cerebral vasospasm.