We present two cases of carotid endarterectomy (CEA) performed using intraoperative ultrasonography, which effectively prevented cerebral embolism. The first case is of a 74-year-old man who presented with mild left-leg motor weakness. Magnetic resonance imaging showed a cerebral infarction in the right frontal lobe, and magnetic resonance angiography (MRA) showed high internal carotid artery (ICA) stenosis. CEA was performed to prevent a cerebral infarction. Intraoperative ultrasonography performed after arterial suturing revealed a thrombus in the common carotid artery. Cerebral infarction was prevented with thrombus removal. The second case is of a 69-year-old man with a left watershed cerebral infarction with mild right hemiparesis. MRA revealed moderate stenosis of the left ICA. CEA was performed for moderately symptomatic ICA stenosis. Intraoperative ultrasonography revealed a thrombus in the ICA after arterial suturing. Cerebral infarction was prevented with thrombus removal. CEA is a preventive procedure; therefore, complications must be avoided. Intraoperative ultrasonography is useful for preventing cerebral embolism during CEA.

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