The range of surgical management of the carotid arteries becomes every day wider. The most common cause of carotid arteries disease is atherosclerosis and its consequences for the brain, and more rarely anatomical anomalies. The majority of our patients had cerebral damage prior to the surgical procedure, so we have taken particular care to prevent cerebral perfusion disturbances following the operation. Consciousness disorders are not always the consequence of disturbed cerebral perfusion, but their cause may have effect on it. Our experience and observations are presented with the aim to alert those considered to the potential problems.