In this article, the authors describe their standard technique for carotid endarterectomy and discuss the various surgical options and different variations of the procedure. Although there are numerous ways to perform carotid endarterectomy, several basic principles of carotid reconstruction must be adhered to. The surgeon must have complete preoperative knowledge of the patient's vascular anatomy, must maintain complete vascular control at all times, must have sufficient working anatomic knowledge to prevent harm to adjacent structures, and must assure the patient a patent repair that is free of technical errors. The most important factor in assuring a technically acceptable carotid surgery is the availability of a skilled cerebrovascular surgeon who has demonstrable morbidity and mortality rates below 3% and a proper understanding of both vascular principles and cerebral physiology.