Objective To explore the application value of 64 slice spiral CT angiography (CTA) and color Doppler ultrasound (CDUS) in carotid endarterectomy. Methods A total of patients with ischemic cerebrovascular disease and carotid artery stenosis confirmed by digital subtraction angiography (DSA) underwent endarterectomy. CDUS and CTA were performed before and after operation to evaluate the relief of carotid artery stenosis. Results The accuracy rates of CTA in the diagnosis of mild, moderate and severe stenosis and complete occlusion were 100%, 95.24%, 85.71% and 85.71%, respectively. The evaluation accuracy rates of mild, moderate and severe stenosis were slightly higher than those of CDUS (P>0.05). The operation was successful in 35 cases and failed in 7 cases, and the success rate was 83.33%. There were 77 stenosis segments in 35 cases. Both of CTA and CDUS showed that the majority of patients had plaques, and after operation, plaques disappeared to different degrees. Some segments with mild plaques remained; CTA showed that there was ulcer on some tube walls while CDUS can not clearly show. After operation, the ulcer basically disappeared. CDUS showed hemodynamic abnormalities, with presence of thrombus or dissection. After operation, blood flow velocity tended to be normal. Postoperative CTA showed that the diameter and minimum residual diameter of the stenosis were significantly larger than those before operation (P<0.05). Postoperative CDUS showed that PSV and EDV were significantly smaller than those before operation (P<0.05). Conclusion The accuracy of CTA in preoperative evaluation of carotid artery stenosis degree is relatively higher. Both of CTA and CDUS have their own evaluation features in carotid endarterectomy. The combination of the two can be used for preoperative and postoperative evaluation of carotid endarterectomy.