We report a case of external carotid artery (ECA) angioplasty and stenting followed by superficial temporal artery (STA) to middle cerebral artery (MCA) bypass for internal carotid artery occlusion with ipsilateral ECA stenosis. A 63-year-old patient presented with moderate left hemiparesis, and imaging studies revealed cerebral infarction at the right corona radiata and right cervical internal carotid artery (ICA) occlusion with severe ipsilateral ECA stenosis. Preventive angioplasty and stenting for ECA stenosis were initially performed to ensure sufficient blood flow to the STA. After 4 weeks, double STA-MCA anastomoses were performed to augment cerebral perfusion. The patient had no postoperative cerebrovascular complications. This therapeutic strategy is thus safe and effective for cerebral blood vessel reconstruction.