“Recycling” A Failed Superficial Temporal Artery Indirect Bypass into a Double Barrel Direct Bypass in Moyamoya Disease

•Novel conversion of a failed indirect bypass into a double barrel direct bypass in moyamoya disease.•Recycling the vessel provides the subset of patients with no other viable STA branches the option of a direct bypass.•Double-barrel direct bypass has the added benefits of increased flow and supply to multiple recipient territories.