Carotid endarterectomy is effective in preventing strokes in patients with symptomatic carotid stenosis greater than 50%. The magnitude of the benefit is greater with increasing degree of stenosis, male sex, greater number of risk factors for strokes, strokes or hemispheric transient ischemic attacks rather than amaurosis fugax, recurrent events, plaque ulceration, contralat- eral carotid occlusion and tandem (intracranial and extracranial) stenosis.The effectiveness of carotid endarterectomy, however, is very sensitive to the rate of perioperative events, and cen- tres providing care for these patients need to prospectively monitor their complication rates.