Persistence of the stapedial artery is rare. A case is presented in which the stapedial artery was found over the footplate during stapes surgery. The technical problems encountered are discussed. A wire prosthesis has previously been used in the presence of a persistent stapedial artery and we describe the use of an all Teflon prosthesis. A subsequent CT scan demonstrated the vessel in the middle ear. An outline of the embryology of the stapedial artery is given and the literature reviewed.