Carotid endarterectomy deals successfully with carotid atheromatous lesions, thus eliminating a potential source of cerebral emboli. At times, however, residual hemodynamic irregularities may occur as a result of technique imperfection or anatomic variations. These irregularities have been associated with a number of immediate and late postoperative complications, such as recurrent cerebrovascular symptoms and secondary episodes of stroke. For this reason, the detection of flow abnormalities or intimal defects in patients undergoing carotid endarterectomy and the achievement of normal intraoperative and postoperative hemodynamics are essential for the elimination of potentially life-threatening perioperative and late cerebrovascular events.