The first report of a successful operation for carotid stenosis in 1954 owes credit to the neurologist Fischer who noted that carotid disease is localized and thus could conceivably be bypassed or locally excised. With this knowledge Professor Pickering of St Mary’s Hospital, London, wisely obtained a carotid arteriogram on one of his patients and suggested to Rob and Eastcott that they surgically correct the block. Their famous successful operation in 1954 startled the medical world. However, only after clinical trials conclusively showed the benefit of carotid endarterectomy in preventing stroke, was it widely accepted. Modern advances in the technique of the procedure are listed.