Atherosclerotic carotid stenosis is a risk factor for stroke and other vascular events. Preventive medical treatment is based on the elimination of risk factors and the use of antithrombotic drugs. Surgery remains the standard revascularization treatment. The benefits of carotid surgery are especially important for severe (> or = 70%) symptomatic carotid stenosis. The benefits of surgery for moderate (> or =60%) asymptomatic stenosis or for moderate (50-69%) symptomatic stenosis are slight, particularly in women. The treatment decision requires consideration of individual factors to optimize the risk/benefit ratio.