Objective: The utilization of selective cerebral shunting during carotid endarterectomy (CEA) has been predicated on surrogate measures such as contralateral carotid occlusion, back-pressure measurements, and the patient's motor and cognitive function with regional anesthesia or recent stroke. This study analyzed the need for shunting in CEA where comprehensive electroencephalography (EEG) monitoring with somatosensory evoked potentials (SSEP) was the sole determinant of the necessity of a shunt. Design: A retrospective review was performed in a single institution of all consecutive CEAs performed between September 2002 and March 2010. The decision for carotid shunting was based only on changes in continuous EEG dynamics reflecting ischemia as assessed intraoperatively by a neurologist. SSEP were used in a portion of cases as a functional confirmation of EEG findings. No other factor influenced the need for a shunt. Patient demographics, including age, degree of internal carotid artery (ICA) stenosis, preoperative neurologic symptoms, and medications were reviewed. Thirty-day outcomes, including stroke, TIA, death, and other major complications were tabulated. Results: A total of 163 patients (100 [62.5%] men; mean age 69.4 years, [range, 44-91]) underwent 169 carotid endarterectomies. Of the total arteries treated, 76 (45%) were symptomatic, of which 66 (39%) had a documented stroke. A total of 20 patients (11.8%) had high-grade contralateral (80%-99%) ICA stenosis and 12 (7%) had contralateral ICA occlusion. Only two shunts (1.2%) were used. The 30-day stroke, TIA, death rates were four (2.3%), zero (0%), and two (1.2%), respectively. There was one intraoperative stroke and the other three strokes occurred ≤30 days. None of the patients with contralateral occlusion or contralateral high-grade ICA stenosis had EEG changes necessitating a shunt. Conclusion: Continuous EEG monitoring with SSEP dramatically reduces the need to place a shunt during CEA. Recent stroke, contralateral ICA occlusion, or contralateral high-grade ICA stenosis are not an indication for intraoperative shunting. Shunting for CEA should be vanishingly rare. EEG with SSEP should be considered the gold standard for monitoring of cerebral perfusion during CEA.