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Over the last century, advances in vascular surgery and surgical technology have changed both our understanding and treatment of cerebrovascular disease. The diagnosis and management of extracranial carotid artery disease have undergone a tremendous evolution of thought and technique. From the days of frequently lethal attempts at carotid artery ligation to current precise surgical techniques, this chapter will describe the most significant events and landmark discoveries that have led to the current standards of care in carotid artery surgery.