BackgroundAneurysms of the cerebral vasculature are relatively common, which grow unpredictably, and even small aneurysms carry a risk of rupture. Rupture of intracranial aneurysms (IA) is a catastrophic event with a high mortality rate. Pieces of evidence have demonstrated that smoking is closely related to the formation and rupture of IA. However, the biological effect of smoking cigarettes on the formation and rupture of IA is still underrepresented. MethodsThe study protocol was prospectively registered in PROSPERO, registration number CRD42020203634. We performed a systematic search in PubMed and CNKI for studies exploring the biological effects of smoking on intracranial aneurysms published up to December 2021, and all studies were included in the analysis. The RevMan software was used for data analysis. ResultsA total of 6,196 patients were included in 14 original articles in this meta-analysis. The risk of ruptured IA in the current smoking group was significantly higher than that in the non-smoking group, with statistical significance (RRtotal = 1.23, 95% CI: 1.11-1.37). After heterogeneity among cohorts was removed by the sensitivity analysis, there was still a statistically significant difference in the risk of ruptured IA between the smoking and non-smoking groups (RR total = 1.26, 95% CI: 1.18-1.34). There was no statistically significant difference in the risk of ruptured IA between the former smoking (smoking cessation) group and the non-smoking group (RRtotal = 1.09, 95% CI: 0.50-2.38). After heterogeneity among cohorts was removed by sensitivity analysis, there was still no statistically significant difference in the risk of ruptured IA between the former smoking (smoking cessation) group and the non-smoking group (RRtotal = 0.75, 95% CI: 0.47-1.19). The risk of the ruptured IA in the current smoking group was significantly higher than that in the former smoking (smoking cessation) group, with a statistically significant difference (RRtotal=1.42, 95%CI: 1.27-1.59). ConclusionAlthough the biological effects of smoking on the formation and rupture of IA are unknown, this study suggests that current smoking is a risk factor for ruptured IA. Quitting smoking is very important for patients with IA.