Changes in surgical techniques may affect outcomes of carotid endarterectomy (CEA). Numerous studies have attempted to determine whether eversion CEA is safer and more effective than conventional CEA. Randomized controlled trials comparing eversion to conventional technique for CEA have been identified and systematically analyzed by the Cochrane Stroke Review Group database. Outcomes included stroke and death, carotid restenosis/occlusion, and local complications. There is evidence that eversion CEA is an effective surgical option comparable to conventional CEA. In literature no differences were found between eversion CEA and conventional CEA with respect to operative morbidity and mortality. Evidence-based data indicated that eversion CEA had a lower restenosis rate than conventional CEA with primary closure techniques, however, no differences in late stroke-free survival rate and superior long-term durability when compared to patch closure were found. Recent studies, as well as our single center experience, indicate that shunt use in eversion CEA is feasible with comparable complication rate versus use of shunt in conventional CEA, although it may require specific experience with the technique.