Carotid atherosclerosis is one the main risk factors for ischemic stroke. Based on NASCET and ECST results, carotid endarterectomy is strongly recommended for severe symptomatic stenosis. However, in the past several years, carotid artery stenting has emerged as a potential therapeutic alternative to carotid endarterectomy. The main limitation of carotid stenting is the potential risk of thromboembolic complication. Recently, cerebral protection during carotid stenting is technically feasible and clinically safe. In the published data of prospective registry with cerebral protection, the incidence of periprocedural neurologic complications was lower than in registries without cerebral protection and similar to the best results reported for carotid endarterectomy. The future status of the endovascular approach will be determined by randomized trials directly comparing carotid artery stenting with cerebral protection and endarterectomy. Occlusive atherosclerotic disease involving the intracranial cerebral vessels can be managed medically with antiplatelet and anticoagulant drug therapy or surgically. However, in patients who are unresponsive to medical therapy or who have unacceptable surgical risks, percutaneous angioplasty with stenting is an attractive alternative that can be performed in selected patients with relatively low risk and good clinical outcome.