Carotid endarterectomy effectively reduces stroke in patients with TIA or minor stroke and a high-grade carotid stenosis. Carotid endarterectomy is also beneficial in male asymptomatic patients younger than 75 years with high-grade stenosis. Carotid stenting has not been as thoroughly evaluated as carotid endarterectomy in randomized trials. The few trials that have been performed up to now show either inferior results or suggest equivalence. Before accepting carotid stenting as a mainstream treatment for carotid stenosis, this therapy should be as critically evaluated as carotid endarterectomy was in the 1980s and 1990s.