Reconstruction of a stenotic external carotid artery associated with occlusion of the ipsilateral internal carotid artery is described in four cases. In two of them there was also a significant stump of internal carotid artery following the occlusion, and the stump was oversewn at the reconstructive operation. All four patients improved after the operation. Two still required medication which, however, had been ineffective preoperatively but now was beneficial. Reconstruction of the external carotid artery is indicated in patients with ipsilateral occlusion of the internal carotid artery and symptoms of artery-to-artery embolization.