The purpose of this study is to assess the 30-day postoperative incidence of death, myocardial infarction, stroke, wound complication, and cranial nerve damage after carotid endarterectomy using induced hypertension (systolic pressure > or = 160 mmHg), selective shunting, and primary closure. We retrospectively analyzed the records of 206 patients who underwent a total of 239 carotid endarterectomy surgeries between January 2002 and August 2009 to identify the impact of selective shunting and primary closure on morbidity and mortality. Two hundred thirty-nine surgeries were performed on 206 patients. The study population was 55% men and 45% women with average age of 67 years (range 33-85 years). Of these patients, 181 had hypertension (88%), 82 had diabetes (40%), 73 had peripheral vascular disease (35%), 107 had coronary artery disease (52%), 142 had tobacco abuse (69%), and 146 had dyslipidemia (71%). Twenty-six patients (13%) presented with history of stroke, 77 (37%) with transient ischemic attack (TIA), 14 (7%) with amaurosis fugax, and 108 (52%) were asymptomatic. The average internal carotid stenosis was 74% as indicated by duplex, computed tomography, magnetic resonance imaging, or angiogram. Of the 239 surgeries, 3 (1%) required patch closure, and 7 (3%) required shunt. Thirty-day postoperative complication rates are as follows: stroke, 3 (1.3%); TIA, 4 (1.7%); bleeding, 5 (2.1%); superficial wound infection, 2 (0.8%); heart attack, 1 (0.4%); cranial nerve injury, 0; and hospital death, 0. One patient (0.4%) died at home from an unknown cause. In conclusion, carotid endarterectomy with selective shunting and primary closure is a safe and effective surgical means of preventing stroke.