BACKGROUND Comparison of carotid endarterectomy in patients with and without occluded contralateral carotid artery. METHODS METHODS evaluation of results without using shunt or patch. METHODS <<Aretaeion>> Hospital, Medical School, University of Athens. METHODS 235 patients, divided into group I of 40 patients with and group II of 195 patients without occluded contralateral carotid artery. METHODS carotid endarterectomy under general anesthesia. METHODS heparin administration, stable hemodynamic status during clamping, short duration monitoring postoperatively. RESULTS Postoperative morbidity of both groups was 2.5% (6/235) and mortality 1.7% (4/235). Group I: mortality rate was 2.5% (1/40) major and minor stroke each 2.5% (1/40) and group I: 1.5% (3/195) and 1% (2/195) respectively (NS). Four to 108 months later, 30% (12/40) of group I and 21% (41/195) of group II died. CONCLUSIONS Endarterectomy of the carotid artery under general anesthesia without use of shunt and patch in patients with or without occlusion of the contralateral carotid artery presented the same comparative results. Candidates for carotid endarterectomy should be screened systematically for coronary disease preoperatively and annual stress testing postoperatively, tactics which may improve early and late mortality rate after carotid surgery.