Chiari,1 in 1905, described arteriosclerotic changes in the carotid bifurcation capable of producing cerebral symptoms. Hunt,2 in 1914, and Fisher,3,4 1951 and 1954, again drew attention to these fundamental changes derived from the study of pathological specimens. The advent of arteriography confirmed and delineated the site of extracranial obstruction. Eastcott et al.5 reported this first successful repair of a partially obstructing internal carotid artery. Numerous subsequent contributors have added experiences and surgical techniques to the surgical treatment of this condition.6-8 We are reporting our failures and successes in 31 cases of complete and partial obstruction of the internal carotid artery. Presenting and Clinical Signs and Symptoms. —The presenting signs and symptoms of 31 cases undergoing surgical restoration of internal blood flow are listed in Figure 1. It is readily apparent there is no group of consistent presenting clinical findings except a fairly constant correlation of