Since 2004, several large randomized trials have provided important data about the comparison of carotid endarterectomy and carotid artery stenting of more than 2,000 patients with predominantly symptomatic carotid artery stenosis. None of these trials demonstrated clearly an equivalent periprocedural risk of both techniques. Long-term evaluation is also pending. Thus carotid endarterectomy remains the gold standard in treatment of symptomatic carotid artery stenosis. The frequently performed endovascular treatment of asymptomatic carotid stenosis is not supported by study data.