A growing number of patients with atherosclerotic stenosis of the carotid artery are being treated endovascularly by percutaneous transluminal balloon angioplasty and vascular stent placement (angioplasty and stenting). However, there is considerable controversy surrounding the use of this procedure. Like many controversial issues in medicine, there are both political and scientific aspects to consider. If all treatment modalities for atherosclerotic carotid stenosis fell within the scope of a single specialty, much of the current hue and cry would be absent. In this short essay, I will outline the scientific issues regarding the treatment of carotid stenosis and provide a rationale for the use of angioplasty and stenting in selected patients.