Background: Prasugrel as a second generation P2Y12 adenosine diphosphate receptor antagonist which in the cerebral aneurysms with Endovascular treatment have become more emphasized. Objective: To compare the efficacy and safety of prasugrel therapy for intracranial aneurysms with endovascular treatment. Methods: The databases of PubMed, Embase, Cochrane Library databases and China Biology Medicine disc were retrieved with computers for collecting controlled trials about the comparison in the efficacy and safety of prasugrel and clopidogrel published from inception to September 2018. At the same time, the reference materials of included literature were retrieved manually. After rigorous evaluation on literature quality, the eligible data of the trials was extracted and given a Meta-analysis by applying RevMan5.3 software. Results: Of the 96 studies identified, 7 trials were included. Results of meta-analysis showed that compared with patients receiving clopidogrel treatment, novel platelet P2Y12 receptor inhibitor prasugrel were effective in reducing the incidence of thromboembolic events (OR = 0.19, 95%CI: 0.08-0.45, P =.0001), but did not increase the risk of hemorrhagic complication (OR = 1.00, 95%CI: 0.53-1.89, P = 1.00), and the PRU (OR = 0.19, 95%CI: 0.08-0.45, P =.0001) and Percentage inhibition of platelet (MN = 37.05, 95%CI: 33.37-40.73, P <.00001) were controlled in a better range. Conclusion: In antiplatelet therapy after aneurysmal interventional therapy, the second generation of P2Y12 adenosine receptor antagonist prasugrel can significantly reduce the risk of thrombosis without increasing the risk of bleeding.