Aim: To compare the effects of ciprofol and propofol on mean arterial pressure (MAP) management, vasoactive drug usage, and postoperative complications during carotid endarterectomy. Methods: A total of 103 patients were included in either the ciprofol (n=50) or propofol (n=53) group. The MAP was recorded at nine perioperative timepoints from before anaesthesia (T0) to extubation (T8). We focused on the achievement rate of the target MAP during carotid cross-clamping at T4-T6. We also examined vasopressor use (noradrenaline, urapidil) and postoperative complications. Results: In terms of primary outcomes, the ciprofol group exhibited a higher MAP at T3 (before the skin incision; P=0.006) and achieved the target MAP faster at T4-T5 (during carotid cross-clamping and 5 minutes after cross-clamping; P<0.001) than did the propofol group. There were no statistically significant differences between groups at T6 (10 minutes after cross-clamping; P=0.360). Haemodynamic stability during extubation was superior with ciprofol (P<0.001). Regarding the secondary outcomes, the ciprofol group was administered a lower dosage of noradrenaline (P<0.001) and had fewer cases of early cognitive dysfunction (eCD) (P=0.024). Conclusion: These findings suggest ciprofol offers advantages over propofol during carotid endarterectomy by optimising MAP control, minimising vasopressor use, and mitigating postoperative complications. Ciprofol may be the preferable anaesthetic agent in carotid artery-related procedures. Keywords: Ciprofol, Pharmacodynamics, Anaesthesia, Carotid Endarterectomy