Treatment of symptomatic carotid stenosis is of great importance in the secondary prevention of ischemic cerebrovascular disease, and drug therapy, carotid artery stenting (CAS), and carotid endarterectomy (CEA) are the methods and means often used in clinical practice today. The debate on the advantages and disadvantages of these treatment methods has been ongoing. Just as in the boxing ring, where the gold belt is awarded on the basis of strength, a tit-for-tat PK is obviously more convincing in explaining the above issues, especially in clinical practice involving life and health, which is looking forward to the emergence of therapeutic techniques with higher safety and effectiveness for the majority of patients. More rationally designed randomized, controlled, and blinded study protocols will clearly help promote clinical care. Previous small clinical observations abroad have noted that CAS presents a greater risk of intra-treatment stroke and death compared to CEA treatment, and although greater experience with stent manipulation and the development of technologies such as stent materials have reduced some of the risks, this phenomenon still remains true in practice. Numerous units in China perform CAS techniques, while CEA is not often used, and thus there is a lack of scientific data based on national comparisons, but this is not enough to avoid an in-depth discussion of the superiority of clinical treatment techniques. A new study published in The Lancet, ICSS, found that in a study of 1713 patients with symptomatic carotid stenosis, preliminary results showed that the risk of stroke or death at 120 days was significantly lower in the CEA group than in the CAS group, while data on the risk of fatal and disabling stroke at 3 years of the study remain to be analyzed. Also reported in The Lancet Neurology, the ICSS sub-study using diffusion and FLAIR imaging observed more new acute ischemic lesions in CAS than in CEA (50% vs 17%), many of which were still present at 1 month postoperatively, and although most of the lesions were non-symptomatic, their long-term relationship with the occurrence of cognitive impairment, depression and epilepsy needs to be further follow-up.