INTRODUCTION: In the recurrent scenario of ischemic strokes, clinicians are faced with the options of switching to a new antiplatelet medication or using a combination of antiplatelet medications in the acute setting and for long-term secondary stroke prevention, balancing future protective benefits and increased hemorrhagic risks. METHODS: Patients presenting recurrent ischemic stroke that were surgically treated with STA-MCA bypass at our hospital between 2016 and 2021. Criteria inclusion were patients diagnosed with a minor ischemic stroke or TIA in MCA or ICA territory, submitted or not to thrombolysis, without indication for mechanical thrombectomy, presenting with hypoperfusion > 10% in the affected vascular territory. Were excluded patients presenting malignant ischemic stroke >1/3 of the MCA territory, cardiogenic causes, or atherosclerotic disease in cervical carotid arteries. RESULTS: STA-MCA bypass was performed in 10 patients presenting recurrent ischemic stroke. There were 6 males and 4 female patients with an age ranging from 40 to 75 years and a mean age of 59.6 (SD 10.59). Presented initial etiologies were ICA occlusion (40%), MCA occlusion (30%), TIA (10%), Moyamoya disease (10%), and Vertebral Artery occlusion (10%). Middle Cerebral Artery (MCA) was the most common site affected (90%), and the mean initial NIHSS was 11.1 (SD 4.57). 1 Day after surgery, the NIHSS average was 11.1 (SD 4.57), followed by 8.3 (SD 4.98), and 6.7 (SD 5.92) average on days 3 and 14, respectively. When comparing pre-op NIHSS and post-op NIHSS, a significant improvement after STA-MCA Bypass (p = 0.0085) was found. CONCLUSIONS: STA-MCA Bypass can be a feasible option in recurrent ischemic strokes and can be indicated in some cases.