Carotid endarterectomy (CEA) is effective treatment approach to prevent stroke in both symptomatic and asymptomatic patients with carotid artery stenosis. However, cerebral hypoperfusion during carotid artery cross‑clamping may lead to perioperative stroke, and nerve monitoring can be helpful in detection of cerebral ischemia, so as to take relevant treatment therapy. Near‑infrared spectroscopy (NIRS) measures the changes of regional cerebral oxygen saturation (rSO2) which can reflect intracranial perfusion, so as to determine the occurrence of cerebral ischemia. Its technique is simple and non‑invasive, and can perform continuous and real‑time monitoring during CEA. In this paper, the practicality and accuracy of various intraoperative neuro‑monitoring techniques for CEA were analyzed in combination with the latest domestic and foreign studies in recent years. This paper focuses on various intraoperative neuro‑monitoring techniques in CEA, the correlation between NIRS and other monitoring techniques, and the role of NIRS in predicting intraoperative ischemia and postoperative hyperperfusion, which can further understand the clinical role of NIRS, so as to facilitate its application in clinical setting.