Acute carotid blowout syndrome (CBS) was defined as free rupture of the carotid artery associating with catastrophic hemorrhage. Most radiation acute CBSs in nasopharyngeal carcinoma (NPC) are found in petrous segment of the internal carotid artery (ICA) because of high-dose radiation in this area associated with nearby osteonecrosis. The occurrence of acute CBSs in the small branch of the external carotid artery and cervical ICA following radiotherapy in NPC patient is very rare. We present a rare case of NPC with radiation acute CBSs in the ascending pharyngeal and cervical ICA in a 3-month interval that were successfully managed by endovascular embolization.