Background <p>Endarterectomy and patch plasty of the internal carotid artery (ICA) for surgical indications of (symptomatic or asymptomatic) ICA stenosis is an established and frequently performed procedure in the spectrum of vascular surgery. Intraoperative angiography has become the standard for immediate quality control of the operative result as it provides the possibility to document the surgical outcome or if necessary to initiate corrections.</p> Objective <p>The meaningfulness of intraoperative control with angiography is discussed with respect to the reference medical scientific literature and own practical clinical experience. Shortcomings and complications are presented also in comparison to a postoperative 1) second opinion of the angiography and 2) neurovascular Doppler and duplex ultrasonography for the detection of possible predictors for the pathological alterations found.</p> Methods <p>This article presents a narrative compact overview.</p> Results <p>Intraoperative angiography cannot replace postoperative duplex sonography with sufficient and reliable certainty and quality in terms of quality control of the technical performance of thromboendarterectomy (TEA) of the ACI. Duplex ultrasonography can in particular additionally detect local pathological alterations that are not highly stenosing or highly occluding in the form of, e.g., lesions of the intima or media in the clamping area of the common carotid artery (CCA) or distal suture retractions (which are rarely detected primarily by intraoperative angiography) in up to approximately one fifth of patients.</p>