Carotid artery disease is the result of atherosclerosis, if the obstruction of common carotid and the bifurcation of the common carotid artery or internal carotid artery occurred. The embolic phenomenon is the main cause of this obstruction. The role of collateral blood flow (circle of Willis and exracranial anastomosis channels) is very important. During endoarterctomy, the degree of ischemia and postoperative complications depends on the degree of the dependency of cerebral circulation on the ipsi lateral internal carotid artery, and the efficiency of the collateral circulation. There is five folds increase in the incidence of perioperative stroke, with the presence of good cerebral blood flow during the surgery. The aim of this study is to review the anesthetic choices between general anesthesia and regional anesthesia displaying the merits of local anesthetic methods in achieving a reduced hospital stay, patient satisfaction, and fewer complications. Carotid artery disease is defined by the narrowing or lockage of the artery due to laque build-up. The process hat blocks these arteries (atherosclerosis) are basically the same as that which causes coronary artery disease and peripheral artery disease (PAD). The slow build-up of plaque (which is a deposit of cholesterol, calcium, and other cells in the artery wall) is caused by high blood pressure, diabetes, tobacco use, high blood cholesterol and other modifiable risk factors. Carotid endarterectomy is surgery to remove fatty deposits (plaque) that are narrowing the arteries in neck. These are called the carotid arteries.