External carotid endarterectomy.

External carotid endarterectomy may be useful in the management of selected patients who have internal carotid occlusion, persistent neurologic symptoms and additional atheromatous ulceration or stenosis within the carotid bifurcation. The procedure should be associated with a low risk for intraoperative stroke and a reasonable likelihood for symptomatic improvement. If symptoms are not completely corrected by external carotid endarterectomy, superficial temporal artery-to-middle cerebral artery bypass may be performed with greater confidence in a successful hemodynamic result.