Carotid endarterectomy is a surgical procedure in which an atherosclerotic plaque is removed from the carotid artery to avoid future stroke. A small proportion of patients will have adverse effects from surgery and need emergency blood-pressure management to avoid intracranial haemorrhage. This paradoxical risk of operation-related stroke leads to continuing controversy about this procedure. Data for carotid endarterectomy in asymptomatic patients are less conclusive than those for symptomatic patients. Trials are underway to determine the benefits of carotid angioplasty with stenting.