Carotid endarterectomy now has an established place in the management of selected patients with carotid artery disease. This success rests in part on the invasive and non-invasive techniques available for imaging of both the pre- and postsurgical carotid artery. While contrast angiography has retained its place as a key presurgical imaging procedure, newer methods, including Doppler ultrasound, MRI angiography, SPECT, and PET scanning are providing additional anatomic, physiologic, functional, and biochemical information. An understanding of the complementary roles of these procedures is helpful to providers working to prevent strokes of carotid origin.