&NA;Proximal internal carotid artery aneurysm may be treated successfully with internal carotid artery ligation. If this is not tolerated because of ischemic insufficiency, an alternative strategy is possible. This consists of extracranial‐intracranial bypass to increase the collateral circulation and perfusion pressure in the ipsilateral cerebral hemisphere before ligation. Experience with two cases is presented to show that such an approach is feasible.