Carotid occlusive disease remains an important cause of ischemic stroke. The results of large, randomized clinical trials have established the benefit of surgical revascularization in selected patients with symptomatic or asymptomatic carotid stenosis. The introduction of balloon angioplasty and stenting of the extracranial carotid artery as a potential alternative to surgery has been received with enthusiasm by patients and physicians alike. Whether or not this enthusiasm is fully justified has yet to be determined. This article reviews published data regarding the safety and clinical efficacy of carotid angioplasty and stenting. Particular focus is directed towards results from recently completed and ongoing prospective comparative trials of endarterectomy and carotid angioplasty and stenting.