The carotid artery is the main artery leading to the head and face of the body. As the body ages and the blood vessels harden, atherosclerotic plaques can form in the artery, causing carotid artery stenosis. As these plaques increase in size, they can become calcified, bleeding, necrotic, and detached, resulting in carotid artery occlusion and cerebral vascular embolism. In our clinical practice there are many patients with severe carotid artery stenosis detected by carotid ultrasound, which is in the high incidence of stroke, but due to the lack of proper understanding of the benefits and harms of treating carotid artery stenosis and stroke, the patients failed to deal with it in time, and as a result, ipsilateral stroke and hemiplegia occurred. The incidence of cerebral ischemic events in patients with severe carotid stenosis, even when controlled with effective drug therapy, has been reported to be as high as 26% or more within 2 years; and more than 60% of cerebral infarctions are due to carotid stenosis. Carotid artery stenosis has become one of the “number one killers” that endangers people’s health in today’s society. Some patients with mild to moderate carotid artery stenosis may have no clinical symptoms. For those who have clinical symptoms associated with stenosis, it is called “symptomatic carotid stenosis”. Symptoms of ischemia due to carotid stenosis include ischemic stroke, dizziness, memory, disorientation, dark haze, tongue extension, and poor speech. There are two types of ischemic stroke attacks due to carotid stenosis. One type is a transient ischemic attack, which has a sudden onset and lasts for a short period of time, and can be without impairment of consciousness or with a brief loss of consciousness. Patients can report a sudden effect on some neurological function, such as weakness or numbness in one limb, or difficulty with speech or blackness in front of the eyes for a short period of time. It usually lasts for several minutes or hours, and often recovers completely within 24 hours without sequelae. However, this symptom is often recurrent, more often than once a day, and less often than once every few weeks, months or years. Carotid artery sclerosis can also cause persistent cerebral ischemia, which often starts during sleep and develops slightly more slowly, with symptoms peaking in a few hours to 1 to 2 days. The diagnosis of carotid artery stenosis is mainly based on the patient’s clinical symptoms, physical examination and imaging examinations. Currently, the main imaging methods used in clinical practice include carotid ultrasound, transcranial color Doppler, CT angiography (CTA), and digital subtraction angiography (DSA). Angiography showing carotid artery stenosis Treatment of carotid artery stenosis mainly includes control of risk factors, pharmacological treatment and surgical treatment. Control of risk factors that can lead to vascular atherosclerosis is the basis of carotid stenosis treatment. It mainly includes: reasonable control of blood pressure, blood sugar and blood lipids, quitting smoking, proper exercise, weight control and avoiding obesity. Drug therapy mainly includes stabilization of atherosclerotic plaque and anti-platelet aggregation drugs. Statin lipid-regulating drugs and aspirin are commonly used in clinical practice. Drug therapy can only stabilize atherosclerotic plaques, minimize thrombosis and slow down the progression of atherosclerosis, thus reducing the occurrence of cerebral ischemic events, and cannot fundamentally remove plaques or restore blood flow to brain tissue. Surgical treatment mainly includes carotid endarterectomy and carotid stenting. So, what kind of patients need to choose surgical treatment? The purpose of carotid stenosis surgery is to improve the blood supply to the brain and to prevent and treat strokes caused by carotid stenosis. Therefore, patients with the following conditions need to undergo surgery: 1. Significant symptoms of cerebral ischemia; 2. A clear history of transient ischemic attack, or symptomatic attacks even after the symptoms of cerebral infarction are stabilized; 3. Those who cannot be relieved by aggressive medication. When carotid plaque is found on physical examination, the treatment plan depends on the size, softness and hardness of the plaque as well as the presence of plaque rupture. Small plaques, those that do not cause carotid stenosis and non-ulcerated plaques can be treated temporarily without surgery and should be followed and observed, but antiplatelet drugs must be applied to prevent microthrombosis. If carotid artery stenosis is found, appropriate treatment should be taken depending on the degree of stenosis. If the stenosis is less than 50%, it can be treated with thrombosis prevention medication and surgery is not necessary; if the stenosis is 50% to 70%, it can be closely observed and treated with medication if there are no symptoms, and surgery should be performed if there are symptoms; if the stenosis is greater than 70%, the hemodynamics will be significantly affected and there is a high chance of cerebral infarction, so surgery should be performed. Carotid endarterectomy is the only method that can remove the atherosclerotic plaque and reconstruct the normal lumen and blood flow. It is the “gold standard” for the treatment of carotid stenosis in the carotid segment. Removed endarterectomy Carotid artery stenting has been performed gradually since the 1990s and is very popular among patients because of its advantages of minimal trauma and rapid postoperative recovery. Carotid stenting is mainly based on endovascular interventional techniques, using balloons or stents to dilate the stenosis of the carotid artery in order to reestablish carotid blood flow, and is suitable for special groups of people at high risk. However, the cost of treatment is higher compared to carotid endarterectomy. In conclusion, carotid stenosis can cause insufficient blood supply to the brain and lead to stroke. Early detection of carotid stenosis and timely and correct intervention can improve the blood supply to the brain and well prevent the occurrence of stroke.