Objective: To evaluate cervical carotid endarterectomy (CEA) for symptomatic patients with severe carotid stenosis (70%-99%). The evaluation covers methods of determining carotid stenosis, indications of CEA, operative techniques, and postoperative follow up and surveillance.Background :Endarterectomy for symptomatic carotid atherosclerosis is a well-established and universally accepted procedure. The North American Symptomatic Carotid Endarterectomy Trial (NASCET), and the European Carotid Surgery Trial (ECST) uniformly indicated that surgery for symptomatic patients with 70%-99% stenosis attained a significant benefit compared to medical therapy.Methods:We claimed 200 patients, suffering from symptoms and signs related to carotid artery territory, eligible based on complete neurologic examination and brain CT scanning. Those patients underwent duplex scanning of the neck and 45 patients had severe carotid stenosis. We confirmed the degree of stenosis and excluded other lesions in the cerebral vascular tree by cerebral angiography and MRA. We excluded 30 patients from the study. We operated on 15 patients under general anesthesia. Introperative monitoring was used in 6 cases. We did primary closure in 9 cases and patch angioplasty in 6 cases.Results:No mortality was recorded after surgery. We had 2 cases of surgery-associated stroke (13.3%), received medical treatment and improved by time. One case had myocardial infarction (6.6%), five cases had postoperative headache and hypertension (33.3%), one case had wound hematoma (6.6%), and 2 cases had wound infection (13.3%). No cases of nerve injury were encountered. Long term follow-up (6-12months) of the 15 patients who underwent CEA was free of any ipsilateral ischemic symptoms. Long term follow-up of thirty patients treated conservatively showed recurrent ischemic insult in the ipsilateral territory of carotid stenosis.Conclusions:There is an advantage to surgical intervention in symptomatic patients with severe carotid stenosis (70%-99%). Surgery should be offered to those patients provided that a combination of judicious patient selection and superior surgical technique is available.