The randomized clinical trial has been brought to bear on the indications and the search for benefit for the surgical procedure of carotid endarterectomy. Progress has been made and some answers are available. It is not too optimistic to state that in a few years time, we will be able to state with some degree of finality, which patients with symptomatic disease will benefit from carotid endarterectomy, which ones will be better treated with medical therapy alone, and whether or not there is a group of patients, despite being asymptomatic, who should be advised to have this procedure.