This report has reviewed the preoperative evaluation, operative technique, postoperative care, results, and representative pathological findings in 225 carotid endarterectomies. Surgery is generally indicated in patients with: 1. TIA's, and carotid stenosis (lumen diameter less than 2 mm.) or an ulcerated plaque. 2. A stable, mild to moderate neurological deficit with or without TIA's, and carotid stenosis (lumen diameter less than 2 mm.) or an ulcerated plaque. 3. An acute progressive or fluctuating neurological deficit, and carotid stenosis (lumen diameter less than 2 mm.) or carotid occlusion. Surgery should be considered in some patients with: 1. TIA's, and ipsilateral carotid occlusion. 2. An acute partial persistent neurological deficit, and carotid stenosis (lumen diameter less than 2 mm.) or occlusion. 3. No symptoms, and carotid stenosis (lumen diameter less than 2 mm.). Surgery is generally not indicated in patients with an acute severe persistent neurological deficit, and carotid stenosis or occlusion.