Carotid artery disease is often implicated in primary ischemic stroke secondary to thrombosis or embolism and may indicate concurrent cardiovascular disease. Atherosclerosis is the underlying cause of the majority of strokes. It is highly correlated with carotid artery disease because it occurs most often at the bifurcation of the common carotids. Transient ischemic attacks are an important clinical syndrome in the diagnostic evaluation of patients with carotid insufficiency. Amaurosis fugax is typically the most common ocular symptom. In addition to a careful history and physical examination, definitive diagnosis and appropriate management of carotid disease mandates defining the location and extent of stenosis. Noninvasive duplex scanning is an ideal technique for determining which patients should proceed with invasive arteriography and carotid endarterectomy. Clinical trials have now officially established the value of endarterectomy in patients with carotid artery disease.