Stroke is the third-leading cause of death in the United States. It occurs in almost 700,000 people per year and cost an estimated US dollars 57.9 billion in 2006. Atherosclerotic disease is the cause of one third of these strokes, with more than one half of these stenoses being extracranial in location. Carotid stenoses are usually unifocal and 90% occur within 2 cm of the carotid bulb. Currently, carotid endarterectomy accounts for 117,000 surgical revascularizations per year, whereas carotid angioplasty and stenting are performed less than 10,000 times annually. Stenoses amenable to revascularization are the topic of this article.