The role of the anesthesiologist as a perioperative consultant requires a thorough knowledge of current guidelines, a deep understanding of perioperative risk associated with various noncardiac surgeries in order to follow an evidence-based approach to perioperative management. This chapter presents a case study of a 76-year-old male was scheduled for a right carotid endarterectomies (CEA) under general anesthesia after an episode of transient monocular blindness (amaurosis fugax) prompted a duplex ultrasound of the carotid vessels. Preoperative laboratory work-up was significant for a hematocrit of 33 and a serum creatinine of 1.6 mg/dL. The vascular surgeon consulted the anesthesia team for preoperative evaluation. The classification of cardiac risk in noncardiac surgery is based on the incidence of cardiac death and nonfatal myocardial infarction. Patients undergoing vascular surgery have a high incidence of concomitant coronary artery disease and cardiac causes are the most common causes of morbidity and mortality after CEA.