lesion: kinking, stenosis, and aneurysm of the ICA. All marks of atherosclerosis are present in this case: excessive kinking of the cervical ICA, stenosis, and aneurysmal dilatation. The aneurysm could have been treated by endovascular route except that the very narrow lumen just distal to the aneurysm impeded the maneuver. Panel ( a ) angiographic aspect in an oblique projection. Note that the ICA appears with a double kink; the origin of the ICA depicts a severe stenosis, and there is an additional stenosis in the fi rst curve of the kink. The second curve shows an aneurysmal dilatation. Panel ( b ) intraopera- tive aspect with high exposure of the distal ICA, by dividing the posterior belly of the digastric muscle, the stylohyoid, and the styloid muscles (note the “bare” styloid process). The cranial nerves IX, X, and XII were isolated and protected. The entire diseased segment of the ICA is well exposed, up to the carotid canal of the petrous temporal bone. Panel ( c ) the diseased portion was removed, and the continuity of the right carotid axis was reestablished as in the eversion technique, by reanastomozing the ICA to the CCA (note that the XII nerve was left deep to the reimplanted ICA). Panel ( d ) the diseased portions removed. On the left, the plaque occupying the lumen of the distal CCA. In the middle, the plaque at the level of the carotid bifurcation (including the portion occupying the origin of the ECA). On the right, the distal cervical segment of the ICA, comprising the aneurysmal dilatation