Conservative medical treatment of acute occlusion of the extracranial internal carotid artery usually gives mediocre results. When a major neurological deficit is involved, mortality can reach 16 to 55%, morbidity due to definitive deficit 40 to 69% and cure only 2 to 12%. It is thus logical to attempt revascularization as an emergency procedure. In situ intraarterial fibrinolysis is appropriate for acute occlusion in the intracranial territory of the internal carotid involving severe neurological deficits but surgery is more adapted and safer for acute occlusion of the extra-cranial internal carotid. In a personal series of 8 patients, we had 1 death, 1 aggravation, 1 improvement and 5 "cures" (62.5%). Based on data in the literature and our experience, we assessed the advantages of emergency surgery (immediate and definitive re-establishment of the carotid flow and vascularization of the hemisphere before installation of irreversible brain damage) and conditions suggesting chances of success: 1) diagnosis by noninvasive echo-Doppler of the cervical vessels and transcranial Dopler, without preoperative arteriography or CT-scan. 2) operation before 6 hours, 3) quality of the desobstruction, 4) no post-operative anti-coagulant treatment, 5) control of post-operative episodes of hypertension.