This involves the removal of part of the lining of the arterial wall. Thirty years ago, this was a widely practised procedure. It involved removing the inner lining of the artery, opening up the lumen. Unfortunately, removal of the lining of the artery over a long length results in increased thrombogenicity of the arterial wall and progressive occlusion of the artery. This procedure is now reserved for a few specific indications. One of these indications includes narrowing of the carotid artery at the origin of the internal carotid artery. Here, a localised narrowing of the artery in the form of an eccentric plaque may give rise to embolic phenomena. The centre of the plaque ulcerates, blood adheres to this and breaks off, travelling to the brain, giving mini-strokes. Surgical intervention, with removal of this plaque, can prevent this problem from occurring and prevent a major stroke happening.