Background: Endovascular coiling is a minimally invasive technique for managing carotid blowout in head and neck malignancies. Internal carotid artery (ICA) coil extrusion is a rare complication of this procedure, with an increased risk in post radiated neck. Methods: We present a case of advanced nasopharyngeal carcinoma with cervical nodal metastasis treated with chemoradiation and complicated with left ICA blowout which was successfully coiled and embolized endovascularly. Results: He was subsequently presented with left-sided nosebleed. Imaging demonstrated patent occluded left ICA, however with extrusion of coil material into the nasopharynx which was most likely attributed by the soft tissue necrosis in the left parapharyngeal space. He was managed conservatively as his symptoms was mild and self-limiting. Subsequent follow-up imaging confirmed stable coil extrusion. Conclusions: This case highlights the importance of identifying and assessing coil extrusion on imaging, which includes assessment of the location of extrusion, vessel occlusion patency, and potential causes of extrusion. Goals of management for symptomatic patients aims to remove extruded foreign bodies and stabilize the wound to prevent massive bleeding or further coil migration.