Extracranial carotid artery stenosis is accountable for 10–20% of all ischemic strokes. Carotid endarterectomy (CEA) prevents major stroke in patients presenting with focal transient ischemic attacks (TIAs) and minor stroke. Carotid endarterectomy can be performed under cervical block anesthesia (awake patient) or under general anesthesia. Most patients can undergo CEA safely without the use of indwelling shunt. In awake patients undergoing CEA under cervical block anesthesia, the need for indwelling shunt is approximately 10% and under GA with EEG monitoring is 12–18%. Post-carotid endarterectomy stroke occurs in 2–5% of patients undergoing CEA and is most often the result of plaque embolization. Post-CEA site thrombosis and intracerebral hemorrhage following CEA are other causes of postoperative stroke. Perioperative myocardial infarction, cranial nerve palsy, and hematoma in the neck are other complications of CEA.