Carotid artery stenting (CAS) is used as a less invasive substitute for carotid endarterectomy (CEA) and is the treatment of choice for patients with severe carotid artery stenosis in whom CEA might accompany a high risk of complications. Although evidence showing that CAS is more effective than CEA is scarce, CAS has been widely used in Japan in the past 5 years. The development of carotid sinus reflection, cerebral hyperperfusion syndrome, and myocardial ischemia must be carefully monitored to reduce the primary procedural causes of mortality and morbidity. Strict perioperative management by anesthesiologists may improve the treatment outcome of CAS. In future, if CAS is proven superior to CEA, there is a possibility that CAS would become the first-line treatment for carotid artery stenosis.