Carotid endarterectomy (CEA) is an established surgical procedure for carotid stenosis. We present the case of a 74-year-old man who underwent CEA for symptomatic internal carotid artery (ICA) stenosis. During the operation, we found that the hyoid bone (HB) and the superior horn of the thyroid cartilage covered the carotid sheath, preventing adequate visualization. Since this was anticipated based on preoperative examinations, the superior horn of thyroid cartilage was removed with the help of an otorhinolaryngologist. The HB was preserved because it could be retracted, and thereafter we performed CEA. Although CEA is a common procedure, the HB and thyroid cartilage are rarely involved in the operation. We present a case report including literature review of acute cerebrovascular syndrome (ACVS) due to HB and thyroid cartilage obstruction.