Starting from historical considerations, the evolution of carotid surgery is analyzed from its origin, when indications and methods used to rely on the insights of operators to date when indications, influenced by improvements in diagnostic and therapeutic techniques, must match the evidence coming from controlled trials. Current indications are herein produced for symptomatic carotid stenosis, which are considered standard, for asymptomatic carotid stenosis and endovascular procedures, which have yet to be defined. Also indications for carotid surgery in emergency are provided, a chapter which has recently been rediscovered and proposed with good results.