Cerebrovascular disease is one of the three leading causes of death in the elderly, and recent clinical studies have demonstrated that carotid stenosis is one of the major causes of ischemic stroke. palak et al. reported that about 68% of people with ischemic cerebrovascular lesions had varying degrees of carotid stenosis. It has been 50 years since Strully et al. reported carotid endarterectomy (CEA) in 1953. Currently, CEA is the most commonly performed vascular surgery procedure to reduce the risk of stroke in the United States and most Western countries. I. Clinical manifestations of carotid atherosclerotic lesions Transient cerebral ischemic symptoms (TIA) such as dark haze, diplopia, aphasia, unilateral limb motor and sensory deficits can be recovered within a few hours with old stroke, limb weakness, unresponsiveness and memory loss; vascular murmurs can be heard in the neck. The best indication for surgery is the presence of stroke symptoms within 6 months and carotid stenosis of 70% or more. 50% or more symptomatic and 70% or more asymptomatic patients are also indications for surgery. Preoperative laboratory tests include Doppler flowmetry, color ultrasonography, MRA scan, CT scan and DSA carotid angiography to observe the degree of carotid stenosis and the presence of lesions in the brain. Experimental blocking of the internal carotid artery, if no impairment of consciousness and motor impairment of the contralateral limb occurs for more than 3 minutes, it indicates that there is abundant blood supply to the brain and the affected carotid artery can be safely blocked for surgery; otherwise, it is necessary to prepare for placement of carotid diversion tube. (1) Standard carotid endarterectomy Standard carotid endarterectomy (sCEA): It is suitable for most patients with CEA, especially those with high plaque position, and it is simple, convenient and easy to operate when suturing the vessels. However, the biggest disadvantage of this procedure is that longitudinal suturing of the vessel is likely to cause stenosis, which leads to a relatively high restenosis rate, especially in the internal carotid artery, which is most likely to be combined with postoperative restenosis. (2) Standard carotid endarterectomy + patch: In patients with small internal carotid artery diameters, direct suturing along the long axis of the vessel can lead to narrowing of the arterial diameter, so a patch should be added to reconstruct the vessel. The advantages of this approach are that it can reconstruct the vessel, enlarge the lumen, and compensate for the artificially caused carotid artery stenosis by the simple sCEA procedure, and can effectively prevent restenosis. However, the disadvantages are that the suture time is longer than that of simple sCEA, which increases the vascular blocking time and thus increases the risk of cerebral ischemia; an artificial implant is applied intraoperatively, which increases the risk of infection; increases the surgical and hospital costs of the patient; and the distal end of the patch may form a fold later on leading to insufficient cerebral blood supply. This approach should be used with caution in patients with internal carotid artery tortuosity. (3) Reversed carotid endarterectomy Reversed carotid endarterectomy (eCEA): can reduce the incidence of restenosis to 1.7%-1.9%. (4) Retrograde common carotid endarterectomy IV. Surgical complications 1. Surgical stroke: the most common and sometimes serious; 2. Cerebral hyperperfusion syndrome: the main clinical manifestations are limited headache, cerebral hemorrhage on the side of surgery, etc.; 3. Cerebral nerve injury: divided into temporary and permanent nerve injury, including: the hypoglossal nerve, vagus nerve, recurrent laryngeal nerve, supraglossal nerve and mandibular G branch of facial nerve; 4. Incision hematoma, airway obstruction, asphyxia; 5, postoperative restenosis.