Successful covered stent usage for carotid artery injury with active medial projecting extravasation.

•Nontraumatic carotid artery injury with active extravasation—carotid blowout syndrome (CBS) —is relatively rare and highly difficult to treat because of its anatomic factors.•A conventionally direct open approach was performed for CBS, which resulted in miserable morbidity and mortality.•Recently a covered stent has shown highly favorable results for all types of CBS.•The covered stent has some disadvantages: cost, risk of embolism, rebleeding due to infection, inclination for bleeding due to dual antiplatelet therapy.•The covered stent is especially effective for the CBS types in which the rupture point is under the clavicle and involves medially projecting extravasation.