Objective To explore carotid endarterectomy (CEA) and carotid artery stenting (carotid artery stenting), carotid endarterectomy (CEA) and carotid artery stenting, Carotid endarterectomy (CEA) Comparison of the long-term effects of CAS in the prevention of Ischemic Cerebrovascular Disease (ICVD). Methods 105 patients with ICVD admitted to our hospital from May 2021 to July 2023 were selected as the study objects. The patients were divided into CEA group (CEA treatment, n=53 cases) and CAS group (CAS treatment, n=52 cases) according to different surgical protocols. The vascular patency rate, vascular stenosis rate, co-occurrence and cardiovascular events of the two groups were analyzed and compared. Results There were no significant differences in the vascular patency rate at 3 months, 6 months and 12 months after surgery between the two groups (P>0.05). However, the vascular patency rate at 12 months after surgery in CAS group was significantly lower than that at 3 months after surgery (P<0.05). There was no significant difference in the rate of vascular stenosis at 3 months and 6 months after surgery between the two groups (P>0.05). At 12 months after operation, the rate of vascular stenosis in CEA group was significantly lower than that in CAS group (P<0.05). The restenosis rate in CAS group at 12 months after surgery was significantly higher than that at 3 months and 6 months after surgery (P<0.05). The restenosis rate in CEA group at 12 months after surgery was significantly lower than that at 3 months after surgery (P<0.05). There were no significant differences in the incidence of perioperative hyperperfusion syndrome, hypertension, local hematoma and acute carotid artery occlusion between the two groups (P>0.05). However, the incidence of hypotension in CAS group was significantly lower than CEA group (P<0.05). There was no significant difference in the total incidence of cardiovascular events between the two groups (P>0.05). Conclusion Both CAS and CEA have high efficacy and low long-term cardiovascular risk in the treatment of ICVD, but CEA has lower long-term vascular stenosis rate and fewer perioperative complications.