Postoperative stroke is a rare complication following carotid endarterectomy (CEA), but a major outcome endpoint in trials and in clinical practice. Many strokes with symptom onset in the immediate postoperative period are due to surgical-site thrombus. For this reason, management has historically consisted of emergent reoperation without angiography. There are, however, multiple possible etiologies for postoperative stroke including intracranial thromboembolism, tandem extracranial-intracranial occlusion, cerebral hemorrhage, and carotid dissection. Moreover, there have been important advances in the endovascular treatment of acute thrombo-embolic stroke using mechanical thrombectomy. Given the various etiologies for postoperative CEA stroke, optimal management remains controversial. Advances in endovascular and imaging techniques have challenged the historical dogma of emergent open carotid reoperation. In this chapter, we will outline the evidence related to postoperative CEA stroke, the various time courses, and etiologies of said postoperative strokes, along with evidence-based rationale to inform clinical decision-making.