Carotid stenosis is a common cause of ischemic stroke, carotid endarterectomy (CEA) is an important treatment. Elderly patients with carotid stenosis are often complicated with hypertension, coronary heart disease and other basic diseases, which brings greater risks and challenges to surgery and anesthesia. Comprehensive preoperative evaluation and fine intraoperative management are very important for the perioperative safety of patients. This patient had a clear history of cerebral infarction before operation, and had a history of hypertension, coronary atherosclerotic heart disease and interstitial pneumonia before operation. The operation indications and timing were strictly grasped through multidisciplinary consultation before operation. During the operation, comprehensive measures such as strict control of blood pressure, monitoring and protection of important organ functions, maintenance of internal environment stability, anti stress and body temperature protection were taken, the patient passed the perioperative period safely and smoothly, recovered and discharged smoothly.