We simultaneously injected both internal carotid arteries (ICAs) during 3D rotational digital subtraction angiography in a patient with a ruptured anterior communicating artery (Acom) aneurysm and vasospasm. Shaded surface display (SSD) images from this acquisition provided more anatomic detail than did SSD images created from individual ICA 3D rotational digital subtraction angriography. In the evaluation of complex Acom aneurysms, this technique can facilitate the choice of optimal working projections for safer aneurysm coiling.