Carotid disease is one of important cause of stroke, may cause 10-20% of all ischemic strokes. In symptomatic patients, carotid revascularization is indicated in the presence of a stenosis 50% or more. In asymptomatic patients, the indication for revascularization is 60% or more stenosis, based on randomized trials at US and Europe. In clinical practice however, asymptomatic stenoses are usually treated only if luminal narrowing exceeds 70-80%. The choice of the revascularization strategy (endarterectomy versus stenting) should be based on the surgical risk profile of the patient and institutional expertise. Carotid artery stenting is particularly beneficial in patients at high risk for surgery: surgically inaccessible lesions; radiation-induced carotid stenosis prior ipsilateral radical neck dissection prior carotid endarterectomy and severely modical comorbid matients. Results of medical treatment become now improving. There still need more experience to establish treatment strategy for severe carotid diseases.