Carotid atherosclerosis affects thousands of individuals each year. A history of transient ischemic attacks should alert the clinician to the possibility of carotid artery disease. Carotid endarterectomy is of proven benefit in both symptomatic and asymptomatic individuals, with angiographically confirmed carotid stenosis of from 70 to 99%, respectively. Guidelines for the diagnostic and preoperative screening procedures as well as the surgical technique used by the Department of Neurosurgery at the National Naval Medical Center are reviewed.