A 65-year-old male diagnosed as an aortic arch aneurysm by computed tomography and angiography was treated surgically with success. He had had cerebral transient ischemic attack, but no symptoms of central nervous system. Cerebral angiography revealed complete occlusion of the right middle cerebral artery. The aneurysm was resected and replaced with Gelseal knitted Dacron prosthesis under the selective cerebral perfusion combining deep hypothermia. During cardiopulmonary bypass cerebral perfusion pressure was maintained over 50 mmHg, and arterial carbon dioxide tension was controlled by alpha-stat method. To our knowledge this is the first case of surgically treated aortic arch aneurysm complicated with middle cerebral artery occlusion. This experience would be valuable to decide about indication for surgical treatment of an aortic arch aneurysm complicated with cerebral vascular disease.