Indications for carotid endarterectomy have been clarified after the publication of European and North American randomised controlled trials between 1990 and 2004. Recent analysis of pooled data concerning symptomatic carotid stenosis has enhanced the initial results. Surgery in complement to best medical treatment is indicated for stenosis equal or superior to 70% (American calculation of degree of stenosis), especially if the patient is a man, older then 75 years, during the first 2 weeks after the initial neurological event. Benefit of surgery for stenosis between 50 and 69% appears only after 2 years. Surgery is also beneficial for asymptomatic severe stenosis but the precise threshold of carotid stenosis remains unclear. The benefit is lower for women and would be greater in case of stenosis more than 70%, and for patients less than 75 years.