Surgical therapy for cerebrovascular occlusive disease has a rich and fascinating history. Carotid endarterectomy is the most commonly performed operation for cerebrovascular disease. Other ingenious efforts have been tried and, of these, only the superficial temporal middle cerebral artery bypass procedure has been prospectively studied. All efforts at extracranial and intracranial vascular surgery are under scrutiny presently and many feel that the extracranial-intracranial bypass procedure has little, if any, future. The efficacy of carotid endarterectomy will probably be studied prospectively, but, for the immediate future, endarterectomy is a well-established therapy for certain cases of carotid stenosis or ulceration.