Despite many randomised controlled trials there are none that recommend carotid artery stenting (CAS) replaces carotid endarterectomy (CEA) for preventing stroke in patients with atherosclerotic carotid artery stenosis. CAS continues to be attractive due to its minimally-invasive nature and potential benefit in those patients at 'high risk' during open surgery. The belief that CAS will replace CEA is likely misplaced; a complimentary role for each mode of treatment is a more realistic vision for the future. Assessment of the existing data may provide useful information as to the subgroups that have most to benefit from each treatment type, therefore allowing a patient-specific approach to the management of individual lesions. This knowledge, coupled with further advances in the techniques of open and endovascular surgery, will progress the application of CAS and better its results.