Ischemic cerebrovascular disease includes transient ischemic attack (TIA), reversible ischemic neurological deficit (RIND), and complete stroke (CS). The international surgical treatment of ischemic cerebrovascular disease began in the 1950s and 1960s, including carotid endarterectomy (CEA) and intracranial-external artery bypass surgery at one time. The relevant units in China have carried out this work one after another since the 1970s, and included in the national “Ninth Five-Year Plan” research project. The surgical treatment of ischemic cerebrovascular disease is an important part of modern neurosurgery, and CEA is an important tool for treating carotid artery stenosis, which should be paid attention to. I. Indications for carotid endarterectomy (CEA) 1. Recurrent (within 4 months) transient ischemic attacks (TIA) in the cerebral hemispheres or retina, or mild complete stroke without disability, with ipsilateral carotid artery stenosis >70% of the lesion. 2, Those with good general condition and asymptomatic carotid stenosis >70%. 3.Bilateral carotid artery stenosis: the symptomatic side should be operated first; the side with severe symptoms with obvious hemodynamic changes should be operated first. 4.Surgical treatment should be carefully chosen for those with occlusion of one carotid artery and stenosis on the other side. 5.Emergency carotid endarterectomy is suitable for the acute attack of confirmed carotid occlusion, accompanied by the disappearance of previous obvious carotid murmur or severe stenosis (>90%) or complete occlusion of the proximal carotid artery; however, the time window of such surgery is limited to less than 3 hours, which is risky and the efficacy has not been determined, so it should not be used routinely at present. II. Indications for arterial angioplasty (PTA) 1. Symptomatic elderly (≥75 years old) patients with a high risk of other surgical procedures. 2, Recurrent carotid stenosis or stenosis due to radiation. 3, Progressive stroke with severe systemic disease; with thrombolytic therapy. 3. Indications for cranial debulking decompression Cranial debulking decompression can increase cranial volume, reduce intracranial hypertension, increase effective perfusion of brain tissue and improve ischemia. It may be effective in patients with intractable cerebral or cerebellar hemispheric infarcts that have failed to respond to medical treatment. These patients have significant intracranial hypertension, early brain herniation or brainstem compression symptoms, and CT manifestations of large infarcts and edema. There is a lack of systematic evaluation of their efficacy. Recommendations: (1) CEA can be considered for severe carotid stenosis >70% unilaterally with or without symptoms, or if drug therapy is ineffective. Bilateral carotid flow should be evaluated before surgery. (2) Emergency CEA within 24 hours is not recommended for patients with acute ischemic stroke. (3) In cerebral infarction with occupying effect and progressive neurological deterioration, decompression with debridement may be considered in order to save life.