Carotid endarterectomy is a routine procedure in vascular surgery. Besides clinical symptoms and the degree of stenosis, indication for surgery is influenced by the perioperative complication rate. This depends on stroke and the mortality rate and should not exceed 6% in symptomatic, high-grade stenosis, according to the Stroke Council of the American Heart Association. Techniques of carotid disobliteration include the conventional open thrombendarterectomy by means of a longitudinal arteriotomy and the eversion technique. In the former, closure by direct suture or patch plasty are possible. Different methods for cerebral protection during the clamping time exist, of which shunt protection is the most common. The various operative techniques are described and critically discussed.
