Stroke is one of the three leading causes of death in the elderly. It is a type of disease in which the main symptom is sudden fainting, unconsciousness, with distortion of the mouth and eyes, unfavorable speech, hemiplegia or sudden onset of hemiplegia without fainting. There are two types of stroke: hemorrhagic stroke and ischemic stroke. Hemorrhagic strokes are mainly caused by the hardening and rupture of blood vessels in the brain. Ischemic stroke is a clinical manifestation of insufficient or blocked blood supply to the brain, mainly due to atherosclerotic plaques or ulcers in the extracranial or intracranial blood vessels supplying the brain, resulting in significant narrowing or occlusion of the lumen. The annual stroke rate can be as high as 13% in patients with >70% carotid stenosis. Many patients with carotid stenosis are unable to avoid stroke even with conservative medical treatment alone, mainly due to atherosclerotic plaque formation in the carotid bifurcation. High risk factors for plaque formation include smoking, hypertension, hyperlipidemia, diabetes and obesity. The most serious consequence of carotid artery stenosis is stroke, which is caused by narrowing of the carotid artery that reduces cerebral blood flow below a critical state, or by plaque fragments or thrombi that drift with the blood flow to the brain and block larger cerebral arteries. The carotid artery is the main artery of the body leading to the head and face, and it supplies 85% of the blood to the brain tissue when normal. Hypertension and atherosclerosis can directly attack the carotid arteries, especially the beginning of the internal carotid artery, forming atherosclerotic plaques in these areas. These plaques may increase in size and narrow the lumen of the carotid artery, which may affect the blood supply to the brain to a certain extent; they may also become calcified, necrotic, detached, and have surface ulcers. The result can be a severe stroke or cerebral ischemia. Treatment of carotid stenosis is currently divided into non-surgical and surgical treatments. Non-surgical treatment includes control of high-risk factors and stroke prevention. Hypertension, hyperlipidemia, hyperglycemia, smoking and advanced age are high-risk factors for atherosclerosis. Therefore, hypertension, hyperlipidemia and hyperglycemia should be actively controlled to effectively stop the development of carotid artery stenosis. Anti-platelet drug therapy can prevent microthrombosis and thus prevent stroke. Anticoagulation therapy can be applied to patients with transient ischemic attacks who are still symptomatic during the application of antiplatelet drugs. Surgical treatment currently consists of carotid endarterectomy (CEA) and carotid artery stenting (CAS). In layman’s terms, the procedure involves making a small incision in the patient’s neck, cutting open the narrowed carotid artery, removing the sclerotic plaque, and then closing up the incision, and the procedure is complete. The idea of surgical repair of carotid artery stenosis to prevent strokes has become generally accepted. In the United States, with a population of only 200 million, 124,000 cases were included in the study in 2005 alone! But in China, with a population of over 1.3 billion, it is estimated that less than a thousand cases are performed each year! The difference is so huge that we believe it is mainly a matter of perception. Not only do most patients believe that they should not undergo surgery as a last resort, but many clinicians also lack the knowledge to do so. In the case of carotid artery stenosis where drug therapy is ineffective, there is carotid artery stenting in addition to surgical treatment. Both are effective, and neither can replace the other. Many patients with high carotid bifurcations, old and frail patients with cardiopulmonary disease, and patients with restenosis are more suitable for stenting. After carotid artery stenosis surgery, there is still a possibility of recurrent cerebral infarction, mainly due to the progression of atherosclerosis, stenosis of other vascular sites (e.g., intracranial vessels), restenosis of the carotid artery surgery site, and thrombosis. Therefore, anticoagulant drugs should be taken for a period of time after carotid surgery, which should be administered under the guidance of a doctor and should not be increased or decreased without authorization. Oral antiplatelet medication should be taken for at least one year after carotid surgery, but long-term medication is usually required because of the presence of systemic atherosclerosis in all patients. In addition, carotid Doppler ultrasound should be reviewed regularly under the follow-up of the doctor for early detection of restenosis.