The incidence of extracranial carotid aneurysms is low (0.3–0.6%). Atherosclerosis is the most common cause followed by connective tissue disorder and fibromuscular dysplasia. The most common presentation is TIA or stroke secondary to embolization. Larger carotid aneurysms can present as pulsatile mass in the neck with compression of adjacent structures and cranial nerves. CTA and catheter-based angiography are helpful in diagnosis and planning treatment. The primary objective of the treatment is resection of the aneurysm and restoring continuity of the internal carotid artery by end-to-end anastomosis or interposition vein graft. The most common postoperative complication is cranial nerve injury. Vertebral artery aneurysms are extremely rare and are treated by surgical excision or hybrid techniques.