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 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. Whether or not this enthusiasm is justified fully has yet to be determined. This article reviews established and emerging data from clinical trials evaluating the safety and efficacy of carotid endarterectomy, carotid angioplasty, and stenting.