Carotid artery pseudoaneurysms are rare lesions and are increasingly treated by endovascular means. This paper reports the case of a patient presenting with haemorrhage due to a left external carotid artery pseudoaneurysm seven weeks after total laryngectomy for carcinoma. The lesion recurred and rebled after technically successful emergency endovascular occlusion. Subsequent aneurysmectomy and carotid sacrifice resulted in fatal hemispheric infarction. The aneurysm was demonstrated to be infected on white cell study and subsequent histopathology. We propose that infection within the aneurysm itself was a significant factor in its recurrence and rebleeding after endovascular occlusion. If infection is proven or suspected then consideration should be given to early surgical rather than endovascular intervention.