Carotid endarterectomy (CEA) is the gold standard cerebrovascular surgical procedure to restore brain perfusion and reduce the incidence of ischemic stroke in patients with cervical carotid disease. The perioperative risks and challenges of the surgery are important to know. Intraoperative neurophysiological monitoring (IONM) is a valuable tool that can improve the efficacy and safety profile of the CEA procedure. The monitoring methods include electroencephalography (EEG), somatosensory evoked potential (SSEP), motor evoked potential (MEP), transcranial doppler (TCD), ultrasonography, cranial nerve monitoring, carotid stump pressure monitoring, and cerebral oximetry. Each modality has its advantages and disadvantages and needs to be carefully selected in each case. The ideal IONM strategy in CEA should provide early indication of cerebral ischemia or hypoperfusion, reduce the incidence of perioperative stroke, limit unnecessary arterio-arterial shunting, provide the ability to be performed at low cost, and create low impact on the overall procedure time. Multimodal IONM has been proven to be of added advantage over single method monitoring.