The purpose of this article is to correlate the length of the internal carotid artery plaque to the technique of endarterectomy. In a prospective collaborative institutional database from 2007 to 2016 years a total of 250 patients (all of whom were selected according to the German S3 guideline) from department of general, visceral, and vascular surgery, university of Halle–Wittenberg, Germany and the vascular surgery department of LTD “Israeli Georgian medical research clinic helsicore”, underwent ICA endarterectomy at either institutions. Our selection of the technique of the endarterectomy is made by considering the length of the atherosclerotic plaque defined by Scheberle. For a short atherosclerotic plaque we performed eversion endarterectomy (EEA) with cervical blockade (EEA + CB – Short). For a atherosclerotic long plaque, conventional endarterectomy, using intracarotid straight shunt and Patch was undertaken. Under general anesthesia (GA). According to our data during the surgical treatment of internal carotid artery plaque, neurological complications related to eversion carotid endarterectomy with cervical block composed 0%. Those attributed to conventional endarterectomy with intracarotid shunt and patch under general anesthesia composed 1.45%. Thus in case of short atherosclerotic plaque of the internal carotid artery, eversion endarterectomy with cervical block, when the clinical requirements are met, seems to be an optimal choice. For the long atherosclerotic plaque of the internal carotid artery, conventional endarterectomy with the intracarotid shunt and patch–repair under general anesthesia is more suitable option.