In conclusion, it was found that endo-luminal stenting of the brachiocephalic arch vessels is a viable alternative for open surgical bypass and should be the first line of treatment it has an excellent functional outcome, safety, and midterm results. It has excellent results in cases of focal stenotic and good results in cases of total occlusion and long segment stenosis. These results are improving with the development of endovascular techniques. Primary stenting may be considered as method for decreasing post operative angioplasty complications. Open surgical bypasses should be considered for cases in which surgical intervention is indicated for another reason or in lesions after failed angioplasty or in which angioplasty contraindicated.