Abstract. One of the unresolved problems in vascular surgery and neurosurgery is the internal carotid artery extra- and intracranial segments combined lesion, namely the combination of the arterial aneurysm or vascular brain malformation with extracranial brachiocephalic arteries lesions. Currently, there are no clear tactical approaches and recommendations for the brachiocephalic arteries' comorbid pathology treatment. This article shows the treatment experience of 55 patients with combined lesions of the internal carotid artery intra- and extracranial pool: a combination of the intracranial aneurysm or vascular brain malformation with brachiocephalic arteries stenotic lesions or asymptomatic internal carotid artery pathological deformation at the cervical level. Clinical cases were accumulated over 6 years (from 2013 to 2019). The incidence of comorbid pathology was 3.5%. The bigger part of brain vascular malformations (53 of 55 patients or 96%) were asymptomatic. The majority of patients with comorbidity were women (69% or 38 patients). Surgical activity among the target group of patients was 40%, 22 of 55 patients were operated on. Repeated ischemic stroke after asymptomatic internal carotid artery stenting was beared by one patient (4.5%) in the early postoperative period. Most aneurysms in the first group were localized in the anterior sections of the Willis circle (81% versus 11%, p<0.001), saccular aneurysms prevailed (41 patients or 95%). There is an existing necessity of accumulation brachiocephalic vascular pool comorbid pathology surgical treatment experience and major studies conduction that should help in the development of therapeutic algorithms and optimization of surgical tactics for the brachiocephalic pool combined vascular pathology.