BACKGROUND: Extracranial carotid artery aneurysm (ExCAA) is a very rare pathology. However, due to local compression symptoms, risk of CNS ischemia, and the potential risk of rupture, it constitutes a significant clinical problem. The small number of cases, substantial differences in etiology and morphology, and various treatment methods of ExCAA disturb the analysis of this pathology. METHODS: We analyzed patients with ExCAA involving exclusively internal carotid artery (ICA) - morphologically Attigah class I, resulting from dysplasia or atherosclerosis and surgically treated with aneurysm resection combined with arterial reconstruction. RESULTS: We included 9 patients operated on due to ExCAA Attigah class I caused by dysplasia or atherosclerosis. The average aneurysm dimension was 17.4 × 18.9 × 24.2 mm. The tortuosity was statistically significantly larger on the ICA than the CCA (P >
0.001), with no significant difference between the ipsilateral and contralateral sides. For ExCAA correction, classic surgery was performed with aneurysm resection combined with reconstruction of the ICA (primary anastomosis in 7 patients
vascular bypass in 2 patients - one great saphenous vein and one Dacron prosthesis), performed under local anesthesia in 5 and general anesthesia in 4 patients, shunt was used in 2 patients. We noticed postprocedural complications 1 minor stroke, 2 nerve palsy (recurrent laryngeal nerve and the marginal mandibular branch of the facial nerve), which resolved within 3 months. No long-term complications were found during late follow-up (mean follow-up 41 months). CONCLUSIONS: ExCAA Class I Attigah can be successfully and safely treated by surgical excision and ICA reconstruction. The significant tortuosity of the ICA was visible bilaterally, with no significant difference between the ipsilateral and contralateral sides. Many patients with ExCAA 1 Attigah can be operated on under local anesthesia.