&NA;The natural history of postirradiation extracranial cerebrovascular disease is uncertain. Previous reported cases spanning 20 years of carotid surgery are difficult to evaluate, because patients may sometimes have unspecified symptoms, physical examinations, postoperative results, and follow‐up. Also, the evolution of carotid surgery over the past two decades makes it impossible to compare earlier operative technique with the state‐of‐the‐art technique of today. Our series of 7 patients underwent 9 carotid endarterectomies with an average follow‐up period of 46 months. The number of patients is small, and although technically this is a more difficult operation, we feel the results are favorable and may be comparable with endarterectomy procedures in nonirradiated patients. These patients should be approached as if radiation changes are not a major factor when they are considered for reconstructive arterial surgery. (Neurosurgery24:171‐178, 1989)