Fibromuscular dysplasia (FMD) is an unusual form of segmental arteriopathy and may affect the internal carotid artery (ICA). We report a case of carotid FMD in which percutaneous transluminal angioplasty (PTA) was complicated by an intimal tear and required surgical exploration. PTA is a useful form of treatment, but there is a risk of intimal dissection. If this occurs, it may be necessary to excise the intimal flap surgically.