While carotid endarterectomy (CEA) remains the standard surgical intervention at the carotid bifurcation, other surgical approaches are available in select circumstances. Procedures such as carotid sympathectomy and carotid resection have become obsolete due to advances in understanding and technique. Carotid stumpectomy may be indicated in patients with carotid occlusion, particularly when residual stump embolization occurs. Symptomatic carotid kinks can be managed through either straightening and fixation or resection followed by reimplantation into the common carotid artery (CCA). Elective surgical intervention may be considered for specific cases of carotid occlusion or pseudoocclusion. Carotid aneurysms and pseudoaneurysms are predominantly treated using endovascular techniques, though surgical management may be warranted in particular cases. Carotid dissections are generally addressed with endovascular approaches.