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Intracranial aneurysms (IAs) are common lesions in the brain. There is a strong relation between hyperhomocysteinemia (HHcy) and cerebrovascular disease; we perform a retrospective study within the Chinese Han population to explore the association between HHcy and IAs. Two hundred six patients with IAs and 206 control subjects were evaluated for their serum total homocysteine levels. With multiple logistic regression analysis, the association between HHcy and the risk of IAs was estimated. Interaction and stratified analyses were conducted according to age, sex, BMI, smoking status, drinking status, and chronic disease histories. The threshold effect was examined by the two-piecewise linear regression model. The multivariate logistic regression analyses revealed a significant association between HHcy and IAs (odds ratio (OR) = 1.68; 95% confidence interval (CI), 1.02–2.75) after adjusting for classical vascular risk factors. And a 2% higher risk of IAs was observed, which was associated with a 1-μmol/L increase in serum total homocysteine level. The interaction analysis showed that age played an interactive role in the association between HHcy and IAs. In summary, our study provides evidence that HHcy is an independent risk factor for IAs in the Chinese Han population, especially in the elderly subgroup. Taking all the findings into consideration, longitudinal studies and clinical trials of homocysteine-lowering therapy via dietary or medical intervention are needed to assess the causal nature of these relationships. [ABSTRACT FROM AUTHOR]