Internal carotid artery (ICA) aneurysms are rare. The symptoms are related to cerebral embolization, local compression and rupture. Options for treatment include open surgery or endovascular treatment with a covered stent. We report a case of a 67 year old woman with bilateral idiopathic internal carotid artery aneurysms, found during the diagnostic evaluation for an episode of syncope. The right ICA aneurysm was treated with resection and end-to-end anastomosis of the ICA. There were no perioperative complications. Six months later the patient underwent endovascular repair of left carotid artery aneurysm with a covered stent. There were no complications in postoperative period. Treatment options for ICA aneurysms are surgical or endovascular, depending of size, location and anatomic relation to surrounding structures.