Carotid artery stenosis is common in elderly people with atherosclerosis, and about one quarter of strokes are caused by carotid artery stenosis. In general, patients with carotid artery stenosis of more than 75% have a 2-5% chance of having a stroke in the first year, manifesting as hemiparesis, loss of hemianesthesia or hemianopsia. After the first symptom of cerebral ischemia, there is a 13% chance of stroke in the first year. Surgical carotid endarterectomy is the standard treatment for carotid stenosis, but with the development of cardiac coronary angioplasty and advances in endovascular stenting, angioplasty has been further applied to patients with carotid stenosis. Today, carotid angioplasty with carotid stenting is an emerging technique for the treatment of carotid stenosis. Compared to carotid endarterectomy, carotid stenting has a wider range of indications. It avoids the need for a surgical incision in the neck and its complications such as cranial nerve damage and hematoma compression. It requires only a femoral artery puncture under local or light general anesthesia, a cerebral umbrella is pre-positioned distal to the carotid stenosis, and then a metal stent is implanted into the stenotic carotid artery to support the stenosis and allow blood flow. Thus, it is less invasive and has a faster recovery. For patients who cannot tolerate carotid endarterectomy due to poor physical condition, this procedure can still be considered. In addition, it is a good indication for stenting in cases of restenosis after carotid endarterectomy, carotid stenosis near the skull base that makes the procedure more difficult, and carotid lesions caused by radiation. However, the incidence of temporary cerebral ischemia and stroke after carotid stenting is similar to that of surgical procedures (about 6%). The reason for this is the obstruction of the distal cerebral vessels by the small atherosclerotic plaques that are removed during carotid stenting. In recent years, the invention of distal brain protection devices has significantly reduced the complications of stroke (about 3%) by intercepting the small atherosclerotic plaques that are stripped during the procedure, making carotid angioplasty and carotid stenting safer. The treatment of patients is more secure. In conclusion, carotid artery stenting is a safe and effective treatment for carotid stenosis. Of course, it has its drawbacks: it is more expensive; it is also associated with stroke, hemiparesis and even life threatening; in some cases the carotid stenosis is so severe that the delivery device cannot pass through; and it is also associated with restenosis. Therefore, whether stenting or surgery, the appropriate treatment should be chosen according to the patient’s specific situation.