The vascular surgeon has become a key member of the healthcare team that treats patients with cerebrovascular disease. There areapproximately 500,000 new strokes in the United States each year andthe initial mortality to be between 20-30 percent. The history ofcarotid artery surgery began with ligation procedures early in the 16thCentury. Many procedures were done but carotid endarterectomybecame the standard procedure. The arterial anatomy that is importantfor discussion in cerebrovascular disease begins with the aortic archand terminates with branches of the circle of Willis. The cervicalportion of the carotid artery is that part which is accessible for surgicalcorrection but the carotid siphon is inaccessible for surgicalcorrection. The pathology of cerebral vascular disease of extracranialorigin can be divided into flow restrictive lesions and lesions ofembolic potential. By far the most common lesion is theatherosclerotic plaque in the carotid bifurcation. Other pathologicallesions are fibromuscular dysplasia, coils, kinks, aneurysms, arteritisand migraine.