Summary: Objective: Common carotid artery occlusion (CCAO) is a relatively rare disease with a wide range of collaterals. As CCAO can induce dynamic changes in the angio-architectural conditions, treatment should be modified according to the cerebral hemodynamic conditions. Here, we report the surgical treatment of three patients with symptomatic CCAO. Material and Methods: Between January 2010 and December 2016, three patients with symptomatic CCAO were surgically treated. Based on the angiographic findings, including the collateral flow and cerebral blood flow studies, appropriate surgical interventions for individual patients were selected. Results: Two-step vascular reconstruction was performed for Case 1 with CCAO, including a carotid bifurcation and a proximal internal carotid artery (ICA). A left subclavian artery to the proximal left external carotid artery (ECA) bypass was performed using an interposition saphenous vein graft, fol-lowed by the superficial temporal artery to middle cerebral artery (STA - MCA) bypass. For Case 2 with CCAO including a carotid bifurcation, a well-developed muscle branch of the left VA to M3 of the MCA bypass was made using an interposition saphenous vein graft. For Case 3 with a relatively short segment CCAO extending to the proximal ICA, occlusions of the CCA and ICA were successfully recana-lized using two carotid stents. All vascular reconstruction procedures were successfully completed without any complications, with good clinical outcomes in all patients. Conclusion: Surgical vascular reconstruction for patients with symptomatic CCAO can achieve suc-cessful outcomes. Precise preoperative evaluations of the extent of the occlusion and collateral flow are important, with the surgical strategy based on angiography and CBF findings.