Carotid endarterectomy and carotid artery stenting have been performed worldwide to reduce neurologic symptoms and prevent stroke. Preoperative cardiovascular and neurologic evaluations are essential to optimize a patient for surgery and guide the intra- and postoperative management. The primary goals of anesthetic management are to maintain cerebral perfusion and prevent perioperative myocardial ischemia. A shunt may be placed to provide antegrade cerebral blood flow if signs of cerebral ischemia develop during carotid cross-clamping. An awake patient is the gold standard for monitoring the adequacy of cerebral perfusion, although neurologic monitoring may be used if a patient is under general anesthesia. Rapid emergence allows immediate assessment of neurologic function. Any delayed emergence necessitates prompt management and communication to surgeon. All patients need to be closely monitored postoperatively for any neurologic, cardiovascular, or respiratory complications.