There are few head and neck surgeons who have not been face with the problem of an acute carotid artery hemorrhage or an impending rupture of this vessel. If the vessel ruptures, few are survived from this disaster with catastrophic ligation of the artery. But emergent ligation after rupture carries the possibility of severe neurologic complications or even death. The figures reported before strongly indicate that elective ligation of an impending rupture is the procedure of choice. Recently we experienced a case of elective occlusion of carotid artery who had unresectable recurrence in his neck with impending rupture. Left carotid artery embolization was done with detachable balloon and Gianturco coil after carotid artery occlusion test. He showed sufficient collateral circulation without any change of EEG and neurologic function, but transient ischemic attack were developed. It was soon recovered with vasopressor. He survived 38 days without any fear of carotid rupture. His cause of death was thought to be carotid sinus syncope. To our knowledge, this is the first trial of elective occlusion of internal and common carotid artery in our country without violating necrotic wound surgically. The advantage, procedure, pre-test of elective ligation are discussed with our case.