Background Carotid artery stenosis accounts for 15%~20% of ischemic strokes. Carotid endarterectomy (CEA) is the gold standard treatment for symptomatic patients with greater than 70% stenosis at the internal carotid artery, and carotid angioplasty and stenting (CAS) represents an alternative to conventional CEA in certain patient populations. Perioperative stroke and death is a potentially complication following CEA and CAS. Objective The anesthetic management for CEA and CAS will be clarified. Content In this review, the available literatures about controlling of perioperative risk factors, preoperative evaluation, selection of anesthetic methods and anesthetics, intraoperative neurological monitoring and brain protection in patients undergoing CEA and CAS were discussed. Trend Positive and cautious anesthetic managements for CEA and CAS are the key to keep balance between oxygen supply and demand, and reduce the risk of perioperative complications.