Tortuosity of the cervical segment of the internal carotid artery (ICA) can hinder navigation intravascular devices for treating intracranial aneurysms and even complex ICA access techniques can fail. Variations in the course of the internal carotid artery are known as coiling, kinking or tortuosity of the vessel. Such failures have clinical relevance. During endovascular procedures these anomalies difficult the intravascular surgical procedure. A potential alternative is the reconstruction of these anatomic anomalies of the carotid artery using neuro-interventional methods. We present a practical review of the literature.