Complete long segment carotid occlusion presents a treatment challenge. These 
patients cannot be managed adequately by endarterectomy or stenting. Despite 
best medical management, many continue to develop recurrent strokes. In this 
select group of patients, there may be role for flow augmentation techniques 
like superficial temporal-middle cerebral artery bypass. We report a patient who 
was thus successfully treated and remains asymptomatic. The relevant literature 
is reviewed.