Stroke represents a primary health problem in the elderly population. It is the first cause of mortality in women over 65 years, and that of men over 75 years in our country. Atheromatous carotid disease (ACD) is a fundamental etiological factor for the development of ischemic stroke. It is known that approximately 10% of the subjects with stroke have carotid stenosis of 50% or greater. Non-pharmacological management of the ACD in elderly subjects is an increasingly more frequent clinical problem in the daily practice and a subject that is traditionally under debate. The aim of this article is to review the current status of knowledge on this controversial subject and to be able to apply it to our clinical practice.