Objective: To explore the effect of carotid endarterectomy (CEA) on the restenosis rate and survival prognosis of patients with ischemic stroke. Methods: 116 patients with ischemic stroke who were treated in our hospital from January 2023 to March 2024 were selected as the research subjects. The patients were divided into the study group (n=58) and the control group (n=58) according to the random lottery method. The control group was treated with carotid artery stenting. The research group implemented CEA treatment. The carotid blood flow status [Peak Systolic Velocity (PSV), Pulsatility Index (PI)] [PI], neurological function [National Institutes of Health Stroke Scale (NIHSS)], Quality of Life [Stroke Specific Quality of Life Scale (SS-QOL)], rate of arterial restenosis, complications and prognosis of the two groups were analyzed and compared. Results: At 3 months and 6 months after the operation, the PSV and PI of the middle cerebral artery in both groups showed a trend of increasing first and then decreasing. However, the PSV and PI in both groups were significantly higher than those before the operation. Moreover, at 3 months and 6 months after the operation, the PSV and PI of the middle cerebral artery in the observation group were significantly higher than those in the control group (P<0.05). At 3 months and 6 months after the operation, the SS-QOL scores of both groups showed an increasing trend, and the NIHSS scores showed a decreasing trend. Moreover, at 3 months and 6 months after the operation, the SS-QOL scores of the observation group were significantly higher than those of the control group, and the NIHSS scores were significantly lower than those of the control group (P<0.05). The rate of arterial restenosis in the observation group was significantly lower than that in the control group (P<0.05). The incidence of complications in the observation group was significantly lower than that in the control group (P<0.05). There was no significant difference in the survival rate between the two groups (P>0.05). Conclusion: CEA can improve the carotid blood flow status and neurological function, enhance the quality of life, reduce the carotid restenosis rate in patients with ischemic stroke, and improve the clinical prognosis of patients.