The treatment of atherosclerotic carotid stenosis has been controversial. Carotid endarterectomy, as the traditional treatment, has been dominant in foreign countries, while carotid stenting has been developed more rapidly in China. In recent years, with the development of vascular surgery and the attention of some neurosurgeons to ischemic cerebrovascular disease, doctors in China have also started to pay attention to carotid endarterectomy. This has been followed by a debate about the efficacy of the procedure, as there is no unanimous opinion among professionals regarding the trauma, risk, and plaque removal, and it has also created confusion for patients to choose. The International Carotid Stenting Trial (ICSS), a study by Professor Brown and others from the United Kingdom, was recently published in the Lancet Neurology journal. The study included patients with symptomatic carotid stenosis from 50 study centers worldwide, randomly assigned in a 1:1 ratio to either the stenting group or the carotid endarterectomy group, and looked at The long-term outcomes of both stenting and carotid endarterectomy were investigated. The results of this study showed no statistically significant difference in the incidence of disabling stroke or death or 5-year risk between the stenting and carotid endarterectomy groups. Although carotid endarterectomy and stenting are evenly matched in the study, in practice, the risks of the different procedures should be weighed against the characteristics of the patient’s lesion and physical condition, and the choice of treatment for carotid stenosis should be based on the physician’s experience.