Extracranial carotid stenosis is one of the most common causes of ischemic cerebrovascular disease, accounting for about 25% of cases. 1953 Debakey first performed carotid endarterectomy (CEA) for patients with complete occlusion of the internal carotid artery, and now CEA has become the standard procedure for the treatment of carotid stenosis and prevention of ischemic cerebrovascular disease. The indications for CEA are: stenosis of 50%-70%, cerebral ischemic symptoms, especially if the plaque is ulcerated. If the stenosis is greater than 70%, surgery should be performed regardless of the presence of symptoms; regardless of the stenosis, surgery should be performed promptly if there is wall thrombus or floating thrombus at the plaque detected by ultrasound; if the internal carotid artery is completely occluded, surgery is not required in most cases; however, if there are still ipsilateral cerebral ischemic symptoms, conservative treatment is ineffective, and the distal outflow tract is open, surgery can be performed; if the lesion is bilateral, the side with severe stenosis should be addressed first; carotid endothelial dissection Carotid endarterectomy is a high-risk surgery, and once complications occur, it is often disabling or fatal. Strictly grasping the surgical indications, standardizing the surgical operation and scientific perioperative management are crucial to achieve good results.