Extracranial carotid artery disease is commonly seen in patients presenting with stroke symptoms. It is also a frequent incidental finding in patients undergoing evaluation as part of a routine examination in the outpatient setting. Several diagnostic imaging modalities are currently available. Treatment strategies include medical and surgical management. Multiple randomized trials conducted over the past decade have laid a foundation for guidelines on the management of extracranial carotid disease. Evaluation and treatment of patients with vertebral artery stenosis is less understood. We review the evidence for the detection and treatment of patients with extracranial carotid artery and vertebral artery disease.