The carotid artery, the main blood vessel leading from the heart to the brain and other parts of the head, is the “bridge” connecting the heart and the brain. If it is narrowed, the heart cannot supply blood to the brain smoothly, thus causing cerebral ischemia. Data show that more than 60% of brain infarctions are caused by carotid artery stenosis. So, how to open the narrowed carotid artery? What kind of treatment should be chosen? Carotid artery stenosis is mostly caused by atheromatous plaque deposition in the carotid artery, and stroke is mainly caused by plaque or thrombus dislodging to form emboli, causing intracranial artery embolism, which leads to ischemic cerebral infarction in the corresponding brain tissue. Therefore, the aim of treatment is to remove the lesions that can cause emboli to dislodge or prevent them from dislodging. Any patient with suspected carotid stenosis should pay attention to angiography, which can accurately determine the extent and stability of the plaque. Once the plaque is unstable, regardless of the degree of stenosis, prompt intervention should be made to treat it, otherwise the plaque, once dislodged, could easily cause a stroke. Once carotid stenosis is diagnosed, it must be treated to improve the stenosis. The treatment of carotid stenosis includes 2 aspects: surgical treatment and medication. Surgical treatment mainly includes traditional carotid endarteretomy (CEA) and carotid artery angioplasty and stent placement (CAS), which has been widely performed in recent years. Because carotid artery surgery is a technically difficult and risky operation, the indications for the procedure must be strictly determined and observed in order to obtain good surgical results and reduce the incidence of perioperative complications. Which treatment modality to choose has also been the subject of debate in recent years, but overall there are principles. 1. pharmacological treatment is recommended in patients with early mild stenosis, with few symptoms and without systemic treatment 2. Carotid endarterectomy (CEA); there are strict indications for the procedure: (i) one or more transient ischemic attacks within 6 months, (ii) carotid stenosis R70%, (iii) one or more mild non-disabling stroke attacks within 6 months, (iv) symptoms or signs lasting more than 24h and carotid degree R70%. Relative indications; ① asymptomatic carotid stenosis R70%; ② symptomatic stenosis in the range of 50-69%; ③ asymptomatic carotid stenosis <70%, but angiography or other tests suggest that the stenotic lesion is in an unstable state. The timing of CEA surgery: at present, we still recommend that surgery is safer after 6 weeks of acute cerebral infarction, but for recent symptomatic episodes, surgery can be chosen within 2 weeks when imaging suggests an unstable plaque [8]; in case of bilateral lesions, the surgical interval between the two sides is at least 2 weeks, with the severe stenosis and/or symptomatic side being given priority; if the patient has complete occlusion of the carotid artery, it should be free of emboli to continue If the patient is completely occluded, surgery does not reduce the incidence of stroke and is therefore not recommended. For symptomatic internal carotid artery stenosis stenting (CAS) with carotid stenosis > 50%, the incidence of stroke and death from all causes within 30 days after surgery in the previous year should be ≤ 6%; the incidence of disabling stroke or death should be ≤ 2%; for asymptomatic carotid stenosis > 60%, the incidence of stroke and death from all causes within 30 days after surgery in the previous year should be ≤ 3%; for asymptomatic carotid stenosis > 60%, the incidence of stroke and death from all causes in the previous year in the operator’s unit should be ≤ 3%; for disabling stroke, the incidence of death from all causes should be ≤ 2%. 3%; the incidence of disabling stroke or death should be ≤1%. The choice of CEA or CAS for patients with carotid stenosis should be based not only on the operator’s proficiency (proficiency reduces the rate of perioperative complications), but also on the patient’s specific situation. In patients with indications, surgical treatment can significantly reduce the incidence of stroke. However, the long-term outcome of surgery cannot be guaranteed without medication in internal medicine. The main drugs are oral antiplatelet aggregation drugs and statins. The main antiplatelet aggregation drugs commonly used are aspirin and clopidogrel. Aspirin is inexpensive and really effective, while clopidogrel is more effective but more expensive. Those with the condition can take it orally for a long time, but those without the condition can stop it after 3 months of overlap with aspirin and switch to aspirin alone. The significance of statins in postoperative treatment of carotid stenosis is not only to lower lipids, but also to stabilize plaque and prevent restenosis. Therefore, they should be routinely administered orally when available. Surgical treatment of carotid artery stenosis has been clinically proven to be effective for half a century. With the increase of morbidity in the country, the number of domestic carotid stenosis surgeries has been increasing year by year. In order to obtain good treatment results, clinicians must be familiar with the pathophysiology of carotid stenosis and strictly comply with the indications for surgery. Through continuous clinical practice, the treatment level of carotid artery stenosis in China will be improved.