The association between vascular cognitive impairment and carotid stenosis and the possible improvements in vascular cognitive impairment favored by the intervention of carotid endarterectomy (CEA) have not yet been clearly defined. The aim of this pilot study was to prospectively evaluate whether cognitive functions can be influenced by carotid endarterectomy performed in patients with asymptomatic severe carotid stenosis. From January to August 2022, 105 consecutive CEAs were performed in patients with severe asymptomatic carotid stenosis at our institution. Of these, 28 provided informed consent for inclusion in the study and were therefore enrolled, representing our study group. The evaluation of the cognitive functions was made by using the Montreal Cognitive Assessment (MoCA), which was administered to the participants at the moment of the preoperative anesthesiologic assessment, usually between 1 and 7 days prior to surgery. Following the intervention and within the third postoperative month, a clinical and instrumental control visit was performed and during that visit the MoCA questionnaire was again administered to the patients. A comparison between the mean corrected pre- and postoperative values of the MoCA questionnaire was performed using Student t test. Multivariate analysis for the factors affecting the lack of postoperative improvement was performed. Patients were more frequently male (18 patients, 64%) with a mean age of 74.4 ± 7.9 years. The mean MoCA test value in the preoperative was 22.68 ± 3.34, thus slightly below the threshold value for identifying the presence of cognitive impairment. The distribution of the values followed a normal pattern. There were nor perioperative deaths neither neurological events. All the patients had their 3-month reevaluation; no neurological events were detected in this period. At the three-month follow-up, the mean MoCA test score was 23.4 ± 3.4, with a statistical trend toward significant improvement (P = .08; 95% confidence interval, −1.8 to 0.34). The most noticeable improvements were found in the visuospatial, language and abstraction domains, while they were less marked in the domains of attention and memory. Multivariate analysis for the factors affecting the lack of postoperative improvement showed a trend toward worse results in diabetic patients, in those with silent ipsilateral brain lesions and in those on neuropsychiatric drug therapy. Our pilot study, consistently with the literature, confirmed a mild cognitive improvement after CEA performed in asymptomatic patients; however, larger studies with a higher number of patients and a longer follow-up are necessary before considering the possibility of suggesting CEA in order to prevent or reverse cognitive decline.