Introduction: Aneurisms of extracraneal internal carotid artery are an infrequent pathology, represent less than 1% of carotid surgeries. The most common etiology is atherosclerotic degeneration and its main symptom is a transient cerebrovascular accident. They can be treated by an endovascular approach or by traditional cervicotomy. Case report: We present the case of a 32-years old female patient, in a cerebral angiography due to a subarachnoid hemorrhage an aneurysm of the extracraneal internal carotid artery was found. Due to an unfavourable anatomy to perform an endovascular approach and the age of the patient, an open repair with arterial resection and anastomosis was performed. Discussion: Although it is an infrequent pathology, it is well known that the arterial resection and anastomosis is a valid treatment with an acceptable range of neurological complications and excellent long-term pattency.