Recent research helped to identify which patients are likely to benefit most from carotid endarterectomy and when the intervention is most effective in patients with symptomatic stenosis. Individual risk modeling is useful in selecting patients for endarterectomy for symptomatic stenosis, although timely surgery and optimal medical treatment are of equal importance. Long-term benefit from endarterectomy for asymptomatic carotid stenosis is limited, and further research is required to identify individuals with asymptomatic stenosis who have the most to gain from surgery.