The extra-cranial aneurysm is relatively uncommon compared to intracranial aneurysm with ischemic symptoms, or with hemorrhage. The causes of extra-cranial aneurysm include atherosclerosis, trauma, acute dissection and infective lesions. There are various reasons as to why the carotid artery aneurysm ruptures, which is a life-threatening problem. The carotid aneurysm rupture can be presented typically by a pursatile mass and it may accompanied by neurologic symptoms such as hemiparesis, aphasia and so on. Although several specific conditions may predispose the carotid artery aneurysm to rupture, aneurysm rupture after endovascular coiling is rare. A 38-year-old male patient with a history of endovascular coiling for external carotid aneurysm had intractable cervical infection and pus drainage. He was diagnosed as tuberculosis (TB) cervical lymphadenitis and treated with anti-TB medication for 2 years. But, it turned out that the carotid arterial wall was ruptured. Herein, we report a rare case of carotid artery aneurysm rupture after endovascular coiling, which was successfully removed without neurological sequelae and reconstructed with pectoralis major myocutaneous flap.