Since aggressive behavior is a major social problem and treatment is only moderately successful, it is important to gain more insight into its underlying neurocognitive causal or perpetuating factors. This study aims to review systematically the current status of empirical studies on the role of risky decision-making in aggression, which has often been under-evaluated. After an extensive literature-search, 16 empirical studies were included, of which most were of moderate quality. Evidence was found across different populations for a significant positive relationship between increased risk taking while making decisions and higher levels of aggression. This relationship appears to be stronger with respect to reactive than to proactive aggression. In violent offenders, the impairments found on risky decision-making tasks may be more profound than those on other neuropsychological (executive) tasks. Violent offenders who make more risky decisions appear to profit less from Cognitive Behavioral Therapy (CBT), making this group extra vulnerable to putting themselves in future high-risk situations with the chance of renewed aggression. It is important to include risky decision-making tasks in the assessment of aggressive individuals, and to find ways to promote advantageous decision-making processes in these individuals first, in order to enhance their responsivity to CBT.