Although no consensus yet exists on the ideal patient characteristics, materials, and indications for carotid angioplasty, it is clear that this procedure which is increasing in popularity will continue to do so. Until such time as the procedure is routinely approved (there are still barriers to insurance coverage for these procedures in the United States), we are highly selective in our application of carotid angioplasty. So far our experience is limited to approximately 40 patients with no major complications and no strokes. However, patient characteristics, operator experience, and patient selection play large roles in the outcomes of these procedures. The current status of carotid angioplasty and stenting wilt be discussed as well as the potential complications and their treatment.