A study published in the American Journal of Vascular Surgery on March 1, 2009, showed that patients with carotid stenosis had a 6-fold higher risk of intracranial hemorrhage after stenting than after endarterectomy (Carlos H. Timaran, Journal of Vascular Surgery, 2009;29:623-629). This complication has been studied primarily because the incidence of intracranial hemorrhage after carotid endarterectomy and carotid stenting, although low, can be a catastrophic complication when it occurs. The 135,903 inpatients who underwent carotid endarterectomy and stenting in 2005 were well documented throughout the United States. The majority of these patients (90.4%) underwent endarterectomy and 13,093 (9.6%) underwent carotid stenting. The majority of patients (92.2%) had asymptomatic carotid stenosis. The incidence of postoperative stroke (2.1% vs 1.1%; P < .001) and in-hospital mortality (1.1% vs 0.6%; P < .001) were higher in the carotid stenting group than in the endarterectomy group. 19 patients in the 13,093 carotid stenting group had intracranial hemorrhage after surgery, an incidence of 0.15%, whereas 20 patients in the 122,810 carotid endarterectomy group had intracranial hemorrhage. The incidence of intracranial hemorrhage was 0.016% in 20 patients in the carotid endarterectomy group, with a significant difference between the two (P < .001). Statistical analysis, after adjusting for age, sex, symptoms, coexisting conditions, hospitalization, and hospital category and regression analysis, showed that carotid stenting was the most common cause of stroke (odds ratio [OR], 1.77; 95% confidence interval [CI], 1.5C2; P < .001), in-hospital death (OR, 1.49 ; 95% CI, 1.2C1.8; P < .001) and intracranial hemorrhage (OR, 5.9; 95% CI, 3.1C11.1; P < .001) were independent predictors. Patients who experienced intracranial hemorrhage had an in-hospital mortality rate of 12.5%. Our data show that carotid stenting has a significantly higher incidence of postoperative stroke and mortality and a 6-fold higher incidence of intracranial hemorrhage compared with carotid endarterectomy. Although the incidence of intracranial hemorrhage after carotid stenting is very low, its prognosis is poor, so it should be given high priority.