<p> Carotid endarterectomy is the gold standard treatment for moderate-to-severe symptomatic and severe asymptomatic carotid artery stenosis. This surgical procedure is widely used and valued for its low morbidity rates. To enhance the surgical accuracy of carotid endarterectomy, various intraoperative completion techniques, including angiography and ultrasound imaging, have been used. However, the necessity and routine use of intraoperative completion studies remain controversial. In this study, a novel intraoperative completion study with three-dimensional computed tomography angiography was applied to carotid endarterectomy, and its efficacy in carotid endarterectomy was evaluated. Intraoperative three-dimensional computed tomography angiography was used as the intraoperative completion study in a hybrid operating room for 35 consecutive patients with carotid artery stenosis. After plaque removal and vessel wall closure, three-dimensional computed tomography angiography was performed following intravenous administration of contrast medium. The success rate, time required, amount of contrast medium used, and patient outcomes were retrospectively evaluated. Good-quality images were acquired in all cases. The intraoperative completion study was performed for 20 min, and the average volume of the contrast medium was 93 mL. Postoperative infarction was not observed in any of the cases, and two patients required intraoperative reintervention according to the intraoperative completion study. This study demonstrates that the use of three-dimensional computed tomography angiography as an intraoperative completion study is minimally invasive and contributes to the prevention of surgical complications.</p>