Background <p>This study evaluated the safety and efficacy of a treatment strategy for Posterior communicating artery (PCOM) aneurysms using first-line Woven EndoBridge (WEB), supplemented by Flow diverter (FD) in selected cases.</p> Methods <p>This retrospective study included patients who underwent endovascular treatment for PCOM aneurysms between January 2021 and March 2025. Aneurysms were categorized as fetal or non-fetal. A first-line WEB strategy was adopted when morphology was suitable. Radiological and clinical outcomes were assessed.</p> Results <p>Forty-six PCOM aneurysms met the criteria: 14 fetal-type and 32 non-fetal-type. All previously untreated fetal-type aneurysms were treated with WEB (<i>n</i> = 9). In the non-fetal group, the initial treatments included WEB (<i>n</i> = 14), FD (<i>n</i> = 10), and coiling (<i>n</i> = 4). All recurrent fetal-type aneurysms were retreated with FD (<i>n</i> = 5), whereas non-fetal recurrences were managed with FD (<i>n</i> = 3) or coiling (<i>n</i> = 1), depending on prior treatment. At a median follow-up of 21 months, complete occlusion was achieved in 66.7% of fetal-type and 59.4% of non-fetal-type aneurysms (<i>P</i> = 0.739), and adequate occlusion was achieved in 75.0% and 90.6%, respectively (<i>P</i> = 0.321). Retreatment was required in two cases (4.3%): one in the fetal group (7.1%) and one in the non-fetal group (3.1%) (<i>p</i> = 0.512). No modified Rankin Scale worsening or major complications occurred. No significant differences in treatment efficacy were observed among modalities selected under the WEB first-line strategy.</p> Conclusion <p>A first-line WEB strategy is safe and effective for PCOM aneurysms, including fetal-type variants, with outcomes for fetal-type aneurysms comparable to non-fetal-type aneurysms.</p>