This Cochrane review analyzes 14 randomized controlled trials involving over 4,500 carotid endarterectomy operations to compare outcomes of the procedures when performed under local versus general anesthesia. The review found no significant difference in the percentage of patients experiencing a stroke or death within 30 days between the two anesthesia types. Specifically, around 3% of patients experienced a stroke and 1% died within 30 days under both local and general anesthesia. The review concludes that either anesthesia technique is acceptable for carotid endarterectomy based on safety and that patient and surgeon preferences can guide the decision.