Carotid endarterectomy, the most commonly performed peripheral vascular surgical procedure, is associated with substantial clinical benefit when performed in patients with significant carotid bifurcation stenotic disease. The rate of morbidity and mortality, however, is significant when performed in patients with medical comorbidities or challenging surgical anatomy. Carotid stenting has emerged as a less invasive alternative to traditional endarterectomy. A large number of clinical trials, both randomized and registry-based, are ongoing. Initial results suggest that the outcome of carotid stenting may be identical to that of endarterectomy in most patients and may also offer additional clinical benefit in patients at high risk from an open surgical approach.