Postoperative carotid artery rupture occurs in 3% to 4.5% of head and neck resections involving a mucosal primary and radical neck dissection. Other indications for carotid sacrifice-ligation include en bloc removal of the artery with tumor, inadvertent injury during surgery, and hemorrhage from vessel erosion by unresectable tumor. The mortality and morbidity of unilateral carotid occlusion are significantly decreased when performed electively in a hydrated and normotensive patient with a normal serum hemoglobin level. Sequelae approximate 5% when adequate collateral cerebral blood flow is present. A transarterial catheter approach to the measurement of carotid artery back pressure and permanent obstruction of flow in an awake patient is presented.