The prevention of stroke in patients with carotid pathology has been traditionally carried out with either medications that prevent clot formation (i.e., warfarin or antiplatelet agents) or revascularization of stenotic segments of the artery by surgical means (i.e., carotid endarterectomy). Recently, the use of percutaneous endovascular techniques, to treat lesions of the carotid artery has become increasingly popular. The most important techniques being used for this purpose are balloon angioplasty and stenting. Although still under intense investigation, it is already clear that endovascular therapy of the carotid artery is effective in the correction of lesions not readily accessible by surgery, those due to recurrent stenosis after endarterectomy, those not of an atherosclerotic nature, and those with unusually high surgical morbidity and mortality. The role of endovascular therapy in the treatment of type A lesions, which are perfect for endarterectomy, awaits the completion of prospective randomized trials. However, care must be exercised in the planning of these trials to allow a fair testing of the endovascular procedures.