Access to the cervical internal carotid artery may occasionally be limited by the mandible. Management of symptomatic carotid occlusive disease in a pa tient suffering from ankylosing spondylitis is described in which the carotid bifurcation is obscured by the vertical mandibular ramus. The application of technique usually reserved for high internal carotid artery lesions to this situa tion is discussed. In the case reported here, the preferred approach of mandibu lar subluxation allowed successful carotid endarterectomy.
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