RECONSTRUCTION of the carotid bifurcation to alleviate cerebral vascular insufficiency is a proven procedure but the selection of patients for operation, the technical conduct of the operation, and the results achieved are areas in which there is a lack of agreement. In an effort to clarify these areas we are presenting our experience with the use of thromboendarterectomy in arteriosclerotic occlusive disease of the carotid artery bifurcation. Occlusive disease of the aortic arch and the innominate, subclavian, and vertebral arteries is not included. The clinical picture related by the patient with carotid artery insufficiency may be extremely variable, encompassing symptoms from mild "wooziness" to hemiplegia, coma, and death. There is no consistent pattern, probably explained by multiple areas of arterial involvement, anatomical differences producing a variable collateral potential, the happenstance destination of small emboli, and the individual patient's variation in brain area tolerances to hypoxia. However, contralateral hemiparesis, and paresthesias