Objective To evaluate mid- and long-term effect of selective shunting in carotid endarterectomy (CEA) under general anesthesia. Methods A retrospective analysis was made of 129 patients who received CEA in Department of Vascular Surgery of the First Affiliated Hospital of Sun Yatsen University from March 2013 to June 2019. They were divided into shunting group (n=48) and non-shunting group (n=81). Color Doppler ultrasound was performed for the head and neck at 3 months after operation. The patients received a follow-up visit once every 6 months to 1 year. The two groups were compared in the overall survival rate and restenosis-free survival rate. SPSS statistics 20.0 was used to analyze the data. Depending on data type, t test or χ² test was used to compare the two groups. Kaplan-Meier was used to analyze overall survival and restenosis-free survival rate. Results The shunting group had a higher occlusive rate of contralateral carotid artery than the non-shunting group [29.2%(14/48) vs 3.7%(3/81)], the difference being statistically significant (P<0.001). Compared with the non-shunting group, the shunting group had longer clamping time [(22.6±5.9) vs (13.7±4.6)min] and operation time [(168.4±63.3) vs (143.0±50.2)min], more intraoperative bleeding [(108.0±65.2) vs (69.8±53.9)ml], shorter length of hospital stay [(5.5±1.4) vs (6.1±1.7)d], higher usage of patch [60.4%(21/48) vs 25.9%(29/81)], all the differences having statistical significance (P<0.05 for all). No death occurred in both groups at 6 weeks after operation. There was no significant difference in stroke [2.1%(1/48) vs 1.2%(1/81)] and carotid restenosis [(4.2%(2/48) vs 1.2%(1/81)] between the two groups (χ²=0.142, P=0.706; χ²=1.141, P=0.285). Kaplan-Meier analysis showed no significant difference in the overall survival rate (χ²= 0.287, P=0.592) and restenosis-free survival rate (χ²=0.285,P=0.593) between the two groups (P>0.05). Conclusion The selective use of carotid artery shunt in CEA has no effect on the long-term survival rate and restenosis-free survival rate .