Objective: The purpose of this study is to evaluate the results of carotid endarterectomy performed under locoregional anesthesia with invraoperative cerebral protection and selective shunting. Method: We reviewed 107 patients who underwent carotid endarterectomy under locoregional anesthesia, at Hospital das Clínicas da Universidade Estadual de Campinas (UNICAMP), between March 1996 and May 2004. This study is composed of 119 endarterectomies (108 patients), being 69 male (63.8%) and 39 female (36.2%). Mean age was 63 years, ranging from 43 to 83 years. Surgery was performed to treat symptomatic stenosis in 60 patients (55.5%) and asymptomatic stenosis in 48 patients (44.5%). All patients were assessed by color-flow duplex scanning and arteriography. Results: Five patients were excluded from the study, since they required conversion to general anesthesia due to intolerance to carotid clamping. Of the 103 patients submitted to 114 endarterectomies, a shunt was inserted in four patients (3.5%), due to the patient's intolerance to carotid clamping during the surgery. A patch was applied in 19 patients (16.6%). Mortality rate in the immediate postoperative period was 2.6% (three patients), all due to vascular cerebral accident. One patient (0.87%) presented a lower ischemic cerebral vascular accident, and one patient (0.87%) presented hyperfusion syndrome, which progressed to a hemorrhagic cerebral vascular accident. This patient was submitted to aspiration of the cerebral hematoma, with full recovery of the neurological deficit. In the late postoperative period, there was restenosis or occlusion in four patients (5.3%). Conclusion: Carotid endarterectomy can be safely performed in the awake patient, by selective shunting and cerebral protection. Good outcome and low morbidity and mortality rate bring a differential in the treatment of the carotid disease. Copyright © 2005 by Sociedade Brasileira de Angiologia e Cirurgia Vascular.43249254Eastcott, H.H., Pickering, G.W., Rob, C.G., Reconstruction of internal carotid artery (1954) Lancet, 13, pp. 994-996De Bakey, M.E., Crawford, E.S., Cooley, D.A., Morris, G.C., Garrett, E., Cerebral artery insufficiency: One to 11-year following arterial reconstructive operation (1965) Ann Surg, pp. 921-945Movius, H.J., Zuber, W.F., Gaspar, M.R., Carotid thromboendarterectomy (1967) Arch Surg, 94, pp. 585-591De Bakey, M.E., Successful carotid endarterectomy for cerebrovascular insufficiency - Nineteen-year follow-up (1975) JAMA, 233, pp. 1083-1085Deweese, J.A., Rob, C.G., Satran, R., Marsh, D.O., Joynt, R.J., Summers, D., Nichols, C., Results of carotid endarterectomies for transient ischemic attacks - Five years later (1973) Ann Surg, 178, pp. 258-264Beneficial effect of carotid endarterectomy in symptomatic patients with high-grade carotid stenosis (1991) N Eng J Med, 325, pp. 445-453Endarterectomy for asymptomatic carotid stenosis (1995) JAMA, 273, pp. 1421-1448Oderich, G.S., Francisconi, A.B., Francisconi, C.R., Pereira, A.H., Momento ideal para a endarterectomia de carótida após um AVC isquêmico (2001) Rev Col Bras Cir, 28, pp. 280-284Gürer, O., Yapc, F., Enç, Y., Çnar, B., Ketenci, B., Özler, A.C., Local versus general anesthesia for carotid endarterectomy: Report of 329 cases (2003) Vasc Endovasc Surg, 37, pp. 171-177Ballotta, E., Da Giau, G.J., Selective shunting with eversion carotid endarterectomy (2003) Vasc Surg, 38, pp. 1045-1050Tardini, D.M., Yoshida, W.B., Lesões cerebrais decorrentes de isquemia e reperfusão na cirurgia de endarterectomia de carótida (2003) J Vasc Br, 2, pp. 119-128Korompilas, A.V., Chen, L.E., Seaber, A.V., Urbaniak, J.R., Actions of glucocorticosteroids on ischemic-reperfused muscle and cutaneous tissue (1997) Microsurgery, 17, pp. 495-502Mauney, M.C., Buchanan, S.A., Lawrence, W.A., Stroke rate is markedly reduced after carotid endarterectomy by avoidance of protamine (1995) J Vasc Surg, 22, pp. 264-270Timi, J.R., Toregeani, J.F., Miyamotto, M., Ribeiro, I.G., Complicações perioperatórias em endarterectomia de carótida relacionadas a protamina (2003) J Vasc Br, 2, pp. 291-295Moreira, R.R., Endarterectomia da carótida (1998) Cir Vasc Angiol, 14, pp. 154-161Glover, J.L., Bendick, P.J., Dilley, R.S., Restenosis following carotid endarterectomy (1985) Ann Surg, 120, pp. 678-684Feasby, T.E., Quan, H., Ghali, W.A., Hospital and surgeon determinants of endarterectomy outcomes (2002) Arch Neurol, 59, pp. 1877-1881