Fibrodysplasic lesions or tortuosity, involving both ipsilateral carotid and distal vertebral arteries may be treated by a one stage combined procedure of external and internal carotid artery transposition and possibly dilatation of the internal carotid artery. Indications for this technique are uncommon. Only 4 of 969 cerebrovascular reconstructions performed between January 1980 and June 1986 utilized this method. Good results were obtained in all cases. This technique is a satisfactory and simple solution for certain situations requiring vascular reconstruction.