The annual stroke rate can be as high as 13% in patients with >70% carotid stenosis. Many patients with carotid stenosis cannot avoid stroke even with conservative medical treatment alone, mainly due to atheromatous plaque formation at the carotid bifurcation. High risk factors for plaque formation include smoking, hypertension, hyperlipidemia, diabetes and obesity. The most serious consequence of carotid artery stenosis is stroke, which is caused by narrowing of the carotid artery that reduces cerebral blood flow below a critical state, or by plaque fragments or thrombi that drift with the blood flow to the brain and block larger cerebral arteries. The carotid artery is the main artery of the body leading to the head and face, and it supplies 85% of the blood to the brain tissue when normal. Hypertension and atherosclerosis can directly attack the carotid arteries, especially the beginning of the internal carotid artery, forming atherosclerotic plaques in these areas. These plaques may increase in size and narrow the lumen of the carotid artery, which may affect the blood supply to the brain to a certain extent; they may also become calcified, necrotic, detached, and have surface ulcers. The result can be a severe stroke or cerebral ischemia. In layman’s terms, the surgery is done by making a small incision in the patient’s neck, cutting open the narrowed carotid artery, removing the sclerotic plaque, and then closing the incision. The idea of surgical repair of carotid artery stenosis to prevent strokes has become generally accepted. In the United States, with a population of only 200 million, 124,000 cases were included in the study in 2005 alone! But in China, with a population of over 1.3 billion, it is estimated that less than a thousand cases are performed each year! The authors believe that the main reason for this huge gap is a matter of perception. Not only do most patients believe that they should not undergo surgery as a last resort, but many clinicians also lack the knowledge to do so. Fortunately, in recent years, this work has been gradually carried out in large and medium-sized cities around the country, and the surgical treatment of ischemic cerebrovascular disease is now included in the national “Ninth Five-Year Plan” and “Tenth Five-Year Plan” and “Eleventh Five-Year Plan The surgical treatment of ischemic cerebrovascular disease has been included in the national “Ninth Five-Year Plan”, “Tenth Five-Year Plan” and “Eleventh Five-Year Plan” key projects. In case of ineffective drug treatment for carotid stenosis, in addition to surgical treatment, there is also carotid stent implantation. Both are effective, and neither can replace the other. However, the authors prefer surgical treatment, and carotid endarterectomy is now a proven preventive method that has been affirmed. Microscopic carotid endarterectomy at Johns Hopkins Hospital has the highest outcome in the United States, with a mortality rate of 0.8%. Recent reports have suggested that the long-term results of the procedure are superior to stent placement. Of course, this does not mean that stenting is not a good idea; many patients with high carotid bifurcations, old and frail patients with cardiopulmonary disease, and patients with restenosis are better candidates for stenting.