This patient has bilateral internal carotid occlusions. A surgical bypass from the right superficial temporal artery (dotted lines) to the right middle cerebral artery (solid lines) was performed to improve intracranial blood flow. This is an end-to-side anastomosis.

A large superficial temporal artery traverses a right parietal craniectomy defect and fills right middle cerebral artery branches. Retrograde filling of the supraclinoid internal carotid artery is aided by the ophthalmic collateral route.