A total of 21 procedures were performed on a group of 17 patients, 13 of them more than 65 years old, for mixed intra- and extracranial vessel disease. Ten had recovered from a frank stroke. Thirteen of them underwent one procedure, three two procedures and one a total of three revascularizations. Eighteen carotid endarterectomies, without patch angioplasty were performed. The determinant factor whether or not to use an intraluminal shunt was the peroperatory encephalographic monitoring by a neurologist. The shunt was used any time significant EEG changes occurred during a test clamping period of five minutes. The other procedures included a vertebral artery endarterectomy with patch angioplasty, a subclavian- subclavian vein by-pass, as well as a common carotid artery resection for elongation and kinking of the internal carotid artery combined with marked stenosis. The mortality was nihil. Postoperatively all patients did well with an improved mental and neurological status.