Anastomosis of the extracranial superficial temporal artery to the intracranial middle cerebral artery offers an additional source of blood to the cerebral circulation in patients with transient ischemic episodes. Fourteen cases are reported. Two representative cases with three anastomoses demonstrate the use of this technique in occlusion of the internal carotid artery, occlusion of the middle cerebral artery and stenosis of the middle cerebral artery. Indications and contraindications of the procedure are discussed.