Extracranial carotid artery aneurysm (ECAA) is an uncommon type of peripheral artery aneurysm. The treatment of this disease requires surgical intervention. Due to the limited number of large studies, the safety and efficacy of surgical and interventional management of ECAA is not well characterized. The optimum treatment has not been clearly defined. The present study reports four cases of ECAA. The patients received end-to-end anastomosis, carotid artery stents and balloon occlusion, respectively. These four cases demonstrate that ECAA may be successfully managed using end-to-end anastomosis. Furthermore, end-to-end anastomosis is a better intervention compared with endovascular treatment as it facilitates the removal of lesions under direct observation. The advantage of open surgery is the surgical repair of end-to-end anastomosis under direct observation. However, few studies have investigated the effect of the timing of resection of an aneurysm on patient outcome and the control of bleeding remains a challenge for surgeons. Therefore, the proximal and distal ends of aneurysm should be under direct observation during surgery.