Carotid endarterectomy (CEA) and carotid artery stenting (CAS) pose risks of cerebral injury and adverse neurological outcomes consisting of perioperative stroke and cognitive decline. This chapter examines the mechanisms of and risks for neurological injury associated with these procedures and the various strategies that are employed to protect the brain and minimize the risk of stroke and cognitive decline, including surgical and anesthetic techniques, blood pressure management, and statin administration. During CEA, neuromonitoring is used to guide surgical technique in order to prevent ischemic stroke due to hypoperfusion during carotid artery cross-clamping and embolic stroke during unclamping. For CAS, cerebral protective devices are the primary neuroprotection technique, with the focus on preventing embolic stroke during manipulation of wires, angioplasty, and stenting.