ABSTRACT:In 9 of 36 carotid endarterectomies performed for relief of cerebral ischemia, ulcerated atheromata were found at the carotid bifurcation; in the other 27 cases the chief feature was stenosis. Three representative cases are presented, including descriptions of how the carotid lesions were studied angiographically before operation. The significance of these lesions is stressed. If carotid ulceration is present, it is recommended that patients with cerebral ischemic symptoms undergo carotid endarterectomy regardless of the degree of stenosis. This aggressive surgical approach should reduce the incidence of strokes due to emboli from carotid atheromata.