Aim:We evaluated the efficacy of superficial temporal artery (STA)-middle cerebral artery (MCA) bypass in the treatment of symptomatic athero-occlusive cerebrovascular disease by retrospectively collecting clinical and radiological data.Material and Methods:A total of 32 STA-MCA bypass procedures in 32 surgical sessions were performed in 30 patients for treatment of athero-occlusive cerebrovascular disease between 2007 and 2012. All patients were refractory to medical treatment and had hemodynamic impairment pre-operatively, confirmed by computed tomography perfusion. A total of 28 patients with 30 bypasses were observed over an average period of 33 months (range, 10-75 months). Results:There was no peri-operative mortality, and peri-operative morbidity of only 3%. During the observation period, 25 patients (89%) had no further cerebrovascular events. Ipsilateral minor stroke occurred in two patients (7%) and ipsilateral major stroke occurred in one patient (3%). Follow-up computed tomography perfusion documented improved cerebral hemodynamics in the revascularized hemispheres. Post-operative bypass patency was clearly verified in 20 (77%) of 26 bypasses. Conclusion:Although bypass surgery for treatment of athero-occlusive cerebrovascular disease is still controversial, our results suggest both an improvement of cerebral hemodynamics and a reduction of risk for future cerebrovascular events after surgery.