Aim — to study an efficacy of surgical prevention of cerebral ischemia in patients with internal carotid artery tortuosity depending on reconstruction. Material and methods. Treatment of 105 patients with ICA tortuosity was analyzed. There were 49 (47%) men and 56 (53%) women (mean age 60±10.9 years). Bilateral and unilateral tortuosity was observed in 70 (67%) and 35 (33%) patients respectively. All patients were divided into two groups depending on reconstruction. Group I consisted of 53 (50.5%) patients after ICA resection followed by reimplantation. 52 (49,5%) patients (group II) underwent ICA replacement. Results. ICA resection is associated with cerebrovascular insufficiency relief in 87% vs. 73% after ICA replacement (p=0.037) and tendency to regression of ophthalmic symptomatology. Both groups were comparable in hemodynamic variables (decrease of blood flow and ICA velocity gradient) in early and long-term postoperative period after surgery. Blood flow in ophthalmic and central retinal arteries were also similar (1.5-fold increase of Vs) in both groups. ICA resection with reimplantation is the most preferred reconstruction in patients with ICA tortuosity due to less cross-clamping time (p=0.0001), accompanied by complete patency of anastomosis in remote period (p=0.039), technically faster than ICA replacement (p=0.0001). This method provides relief of neurological and ophthalmologic symptomatology and prevention of ischemic stroke. Conclusion. ICA resection with re-implantation is the most preferred reconstruction in patients with ICA tortuosity to prevent cerebral ischemia.