The management of carotid bifurcation stenosis is key to stroke prevention, a topic that has received extensive clinical attention (including multiple randomized controlled trials). 2008 saw the development of clinical guidelines for the management of carotid stenosis by the Society for Vascular Surgery (SVS). At that time, only one controlled study of carotid endarterectomy (CEA) and carotid stenting (CAS) was published. Since then, four major randomized controlled studies have been published, and the importance of standardized medical therapy has been repeatedly emphasized. This guideline has been enhanced and expanded from the 2008 edition in the following six areas: 1) imaging to define the nature and extent of carotid stenosis; 2) medical treatment (alone or in combination with interventional therapy); 3) risk stratification to select the appropriate treatment modality (CEA or CAS); 4) technical aspects of CEA or CAS; 5) the relevance of CEA or CAS; 6) extracranial The management of uncommon cases of carotid artery disease. As with other vascular surgery society guidelines, the GRADE system is used for the recommendations in this guideline. The Society recommends CEA as first-line treatment for the vast majority of asymptomatic patients with 60-99% carotid stenosis and symptomatic patients with 50-99% stenosis, provided that the perioperative stroke rate and mortality are less than 3% to ensure patient benefit. CAS is not recommended for asymptomatic patients; if asymptomatic patients are at high risk for intervention or have a life expectancy of less than 3 years, medical therapy is recommended as the first-line treatment option.