This presentation’s objective is to identify efficacy of the surgical treatment of critical carotid stenosis using direct endarterectomy, in our experience. It’s been over 50 years since the first CEA and 15 years since the publication of the Nord-American and European trials’ results- which stated surgery as the elective procedure of treatment for the extracranial cerebrovascular occlusive disease.Material and Method: Our experience consists of 411 cases of carotid endarterectomies (1997- June 2011). There were 139 asymptomatic patients and 272 symptomatic patients, 173 with minor stroke, 99 with TIA. 380 carotid endarterectomies were performed, followed by venous patch angioplasty in 332 cases, Dacron patch angioplasty in 39 cases and PTFE patch in 8 cases. There were 31 cases of primary closure of the arteriotomy, and 5 patients with bilateral simultaneous carotid endarterectomy.Results: 2 patients suffered postoperative major stroke (one ischemic, one hemorrhagic) and 4 deaths (2- AMI and 2- major stroke). Mortality and combined mortality/perioperative stroke rate was of 1,21 % (only in symptomatic patients). Conculsions: In our experience, carotid endarterectomy remains the method of choice in critical carotid stenosis treatment.