The authors describe their experience with 40 patients operated upon during the last five years because of pathological processes of the large blood vessels of the neck. In seven cases pathological conditions unrelated to the systematic diseases of the arteries (birth defects, the results of injuries and tumours) existed, while the remaining 33 patients suffered from arteriosclerotic lesions most commonly located on the carotid artery. The localization of the pathological process and the number and extent of the neurological lesions are described. The authors particularly stress the importance of the period which elapses from the first signs of ischemic lesions to the moment of surgical intervention. The aim of surgical intervention is primarily to prevent ischemia and simultaneous cerebral apoplexy, and only after this to prevent the progressions of the existing ischemic changes. Patients with temporary attacks of ischemia without neurological attacks are ideal cases for surgical intervention. Good results can be achieved on patients with apoplexy within the first six hours from the moment at which the attack occurs. Intervention after a longer period gives uncertain results. Good results can be expected only when the diagnosis and localization of the vascular changes are exact and the neurological and general condition of the patient is precisely evaluated. This demands team work by the roentgenologist, the neurologist and the vascular surgeon.