Population-based studies indicate that the prevalence of carotid stenosis is 0.5% in the sixth decade of life but increases up to 10% by the age of 80 years. Ipsilateral carotid stenosis, with >50% of the artery occluded, is found in about 10% of carotid territory ischemic strokes and in about 15% of transient ischemic attacks (TIA), and is associated with a high-risk of recurrent stroke. Treatment of carotid artery disease plays a major role in stroke prevention. In this article we focus on the role of carotid artery angioplasty and stenting as compared with carotid endarterectomy. We summarize the current positions of the Calgary Stroke Program and the Dresden University Stroke Centre in the treatment of patients with extracranial carotid stenosis as examples for a North American and a German Stroke Centre.