Atherosclerotic stenosis of the internal carotid artery is a frequent and serious condition, with a high risk of ischemic neurological events homolateral to the stenosis, which are often severe. Indications for surgery depend on two key factors: the degree of stenosis, and whether it is symptomatic or asymptomatic. These indications are now well codified, thanks to major randomized trials which have demonstrated the vital role of surgical treatment in improving the prognosis of carotid stenosis, taking into account the cumulative morbidity-mortality rate (CMMR) of the surgical team.Despite recent advances in interventional catheterization, which have attempted to introduce percutaneous angioplasty with or without stent into the therapeutic armamentarium of carotid atheromatosis, carotid endarterectomy remains the reference method for the treatment of atheromatous carotid stenoses.