Seventy-four patients presented with cerebrovascular disease associated with 60% or more carotid artery stenosis or the presence of ulceration as diagnosed with Duplex scanning had been divided into surgical (A) & medical (B) groups. Carotid endarterectomy (43 procedures) was done for 39 patients group (B). Both groups had been treated with base line medical therapy, had been followed clinically and by duplex for two years with no mortalities. While the incidence of stroke & TIA's was less in group A than group B. Statistical analysis showed the advantage of the surgical management over the medical management which is comparable to the national results.