Atherosclerotic lesions obstructing the external carotid artery are generally disregarded in the evaluation of patients with symptoms of cerebral ischemia; nevertheless, in the presence of occlusion of the ipsilateral or of both the internal carotid arteries, external carotid artery endarterectomy may be indicated, in order to increase the flow to the brain through collaterals. A lesion of the external carotid artery may be the source of retinal emboli; patients may benefit from surgical treatment of the lesion. The Authors of the present paper operated on 6 such patients, from a total of 230 carotid bifurcation endarterectomies performed in the period between January 1982 and March 1988. Morbidity and mortality were nil and 5 of the 6 patients are free of symptoms after a mean follow-up period of 23 months. One patient died 2 months after surgery due to a myocardial infarction. On the basis of this experience, the Authors discuss indications, surgical techniques and results of the surgical treatment of lesions obstructing the external carotid artery.