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Ankara University School of Medicine, Department of Neurosurgery, Ankara The surgical management of patients with symptomatic carotid stenosis in combination with one or more incidental intracranial aneurysms is problematic. We discuss this issue with reference to two cases, and in light of the relevant literature. Our conclusion is that the best management plan is aneurysm clipping via craniotomy, followed by microvascular endarterectomy under barbiturate protection, all in the same surgical session. Keywords : Carotid endarterectomy, incidental aneurysm, surgical strategy