Carotid atherosclerotic stenosis is a known risk factor for ischemic stroke. Methods for detecting stenosis and revascularization abound. The objective of this review was to summarize the evidence for diagnosing carotid artery stenosis and treating symptomatic or asymptomatic stenosis with endarterectomy or stenting. An Ovid MEDLINE search identified relevant original research published between 1990 and 2006. With acceptable surgical risk and patient life expectancy, carotid endarterectomy is clearly indicated for symptomatic stenosis of more than 70%. Carotid endarterectomy is also recommended for symptomatic stenosis of more than 50%, but the health impact is less compelling. The US Food and Drug Administration has approved several stents for a subset of patients with carotid stenosis. Randomized comparisons of endarterectomy vs stenting have been performed in average- and high-risk patients with asymptomatic and symptomatic carotid artery stenosis with mixed results.