Carotid angioplasty and stenting is potentially an alternative to carotid endarterectomy in carotid stenosis, but it remains unclear whether it confers significant advantages over carotid endarterectomy. We reviewed evidence on carotid angioplasty and stenting in carotid stenosis.Carotid angioplasty and stenting is neither safer nor associated with better short-term outcomes in patients with symptomatic carotid stenosis who are not at increased surgical risk. It has not been evaluated sufficiently in patients with asymptomatic carotid stenosis who are good candidates for carotid endarterectomy. Patients at perceived high surgical risk may be good candidates for carotid angioplasty and stenting, but there is variability in the definition of high risk, and this procedure has been compared with carotid endarterectomy in only one small randomized trial. Many registries suggest that carotid angioplasty and stenting is as safe as carotid endarterectomy, but it is uncertain whether those patients really benefit from any carotid revascularization strategy.Carotid endarterectomy is still the 'gold standard' for treatment of patients with carotid stenosis who are good candidates for carotid endarterectomy. Although carotid angioplasty and stenting may be an acceptable option in selected patients, much remains to be done to identify patients who benefit more from it than from carotid endarterectomy.