Abstract Real-time intraoperative angiosonography is a readily available and simple means of obtaining high-resolution imaging of the carotid vessels after endarterectomy. In an experience of 60 intraoperative scans, nine abnormalities (15%) were detected, of which 4 lesions were hemodynamically significant. Three of these abnormalities were in the external carotid artery, and one was in the common carotid artery. The detection of these defects, which usually were not obvious during palpation or inspection, enabled immediate reexploration and correction of the fault to be undertaken. The considerable advantages of the intraoperative method of scanning over the transcutaneous technique and operative angiography are discussed. Immediate intraoperative angiosonography is recommended for routine use after carotid endarterectomy.