Carotid endarterectomy is a prophylactic surgical intervention aimed at preventing stroke by removing atherosclerotic plaque from the carotid artery. Proper patient selection is crucial to maximize benefit. Indications differ for patients with symptomatic carotid stenosis (those who have had recent neurologic symptoms related to the carotid artery) versus asymptomatic carotid stenosis (incidentally discovered high-grade stenosis without recent symptoms). Carotid endarterectomy can be performed with various technical nuances, but the fundamental goal is to safely open the artery, remove the plaque, and close the artery in a manner that minimizes the risk of stroke or restenosis. Here we outline the key aspects of surgical technique and relevant evidence or consensus regarding each aspect. We exclude discussion of carotid stenting or other adjunct interventions, focusing solely on variations of the CEA surgical procedure itself.