To compare the incidence of retinal arterial embolism after carotid endarterectomy (CEA) or carotid artery stenting (CAS) as a treatment for carotid artery stenosis and to determine the risk factors for retinal artery embolization, this study included all consecutive severe carotid artery stenosis patients (70-99%), diagnosed by digital subtraction angiography, who underwent CEA or CAS between February 2014 and July 2014. The study included 61 patients in the CEA group and 71 patients in the CAS group. None of the patients developed a stroke or myocardial infarction or died within 7 days of the surgery. A total of 15 patients exhibited retinal embolization including three patients who underwent CEA. None of these emboli caused symptoms. After undergoing CAS, 12 patients exhibited retinal embolization and one of the 12 patients suffered a decrease in visual acuity and visual field after CAS. The retinal embolization rate was 4.9% in the CEA group which was lower than the 16.9% rate in the CAS group (p = 0.031). In addition, the retinal embolization rate in the ulcerated plaque group was higher than that in the non-ulcerated plaque group (p = 0.007). Ulcerated plaques (odds ratio [OR] 5.043; 95% confidence interval [CI] 1.476-17.225; p = 0.010) and CAS (OR 4.248; 95% CI 1.104-16.343; p = 0.035) were independent predictors of retinal embolization. Although retinal embolization during CEA and CAS is common at our center, symptomatic embolization is not. The presence of ulcerated plaques and CAS were independent predictors of retinal embolization. (C) 2015 Elsevier Ltd. All rights reserved.