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We report our experience with carotid surgery during the past 11 years and a prospective randomized study on 600 patients with conventional thromb-endarterectomy (TEA) versus eversion-endarterectomy (EEA). First results gave EEA a slight advantage, which could not be proved in the following years. Both methods are equivalent in terms of postoperative and long-term results. Follow-up showed one difference between the two methods: Restenosis occurred more often in the TEA-group (14.7% TEA versus 6.5% EEA). The frequency of symptomatic restenosis was the same in both groups (3.8% TEA versus 3.9% EEA). EEA did not show late restenosis. We attribute this to the avoidance of patch-suture and the introduction of patch material, as was observed by other authors. No ruptures of venous patches occurred in our study after primary implantation, while two venous grafts ruptured after substitution of an infected Dacron patch. Infection rate for the Dacron patch was below 0.2% and is therefore negligible. Duplex-ultrasound is indispensable in evaluating plaque-morphology, although sensitivity is low in the detection of dangerous atherosclerotic lesions (73.4% for the soft plaque, 31.9% for ulcerations). In view of these results and a critical analysis of the current literature, we see slight advantages for EEA over TEA inspite of equivalent operative results. However, EEA is a suitable procedure only in connection with subtile intraoperative control and in the hand of an experienced surgeon.