Currently, there are no clear domestic and foreign recommendations for cerebral revascularization, also missing is a definite decision on determining the timing and possibility of carotid endarterectomy in acute ischemic stroke. A set of measures aiming at obtaining a satisfactory outcome of carotid endarterectomy in the acute ischemic cerebrovascular event is developed. To prevent hyperperfusion complications, a temporary shunt, low doses of unfractionated heparin, adequate antiplatelet, hypotensive and lipid-lowering therapy are used. The main advantages and disadvantages of all modern methods of surgical treatment of this condition are presented.Received 22 August 2017. Revised 7 December 2017. Accepted 11 December 2017.Funding: The study was supported by the Siberian Branch of Russian Academy of Sciences within the framework of the fundamental research package program.Conflict of interest: Authors declare no conflict of interest.Author contributionsDrafting the article: A.N. KazantsevResources: A.R. ShabayevArtistic design: N.N. BurkovCritical revision of the article: A.I. Anufriyev, A.V. Mironov, V.Yu. KheraskovSurgical treatment: A.N. KazantsevAssistance in surgery: N.N. Burkov, A.R. ShabayevRevascularization tactic selection: A.I. Anufriyev, A.V. Mironov, V.Yu. KheraskovNeurological examination: E.V. RubanFinal approval of the version to be published: A.N. Kazantsev, N.N. Burkov, R.S. Tarasov, A.I. Anufriyev, A.R. Shabayev, E.V. Ruban, A.V. Mironov,V.Yu. Kheraskov