Acute postoperative thrombosis and late restenosis are well known complications of carotid endarterectomy. Vein or synthetic patches are imperfect solutions leading to occasional infections, false aneurysms and possible rupture. A new technique is described that patches the internal carotid artery with the external carotid artery after complete endarterectomy of both vessels. Twenty-five of these procedures were performed upon 22 symptomatic patients with no early or late morbidity or mortality. Theoretic advantages include wide patching of the internal carotid artery above the endarterectomy end point where narrowing is most dangerous, full endarterectomy of the external carotid artery and double tacking of the endarterectomy end points to deter circumferential intimal flaps.