As the "gold standard" treatment for carotid artery stenosis to prevent ischemic stroke, carotid endarterectomy (CEA) has been widely accepted in the western countries; but was developing rapidly only within the past years in China. We noticed that many surgeons in China can master the surgical skills, but there is still much room for improvement in their concept understanding, surgical procedure selections, technical concepts, complication management and other aspects. Many surgeons are still puzzled by the following questions during their clinical practices, such as "Is it the plaque or intima that should be resected in CEA?" "How to resect?" "How to select the resecting site?" "To what extent should it be resected?", and "Whether to perform additional vascular cutting and anastomotic plasty?". Hereby, we summarize the above four controversies of CEA in the real world, including concept doubt, surgical tangle, conceptual differences and technical confusion. We also put forward our thinkings on the issues and shared the latest developments in this field.