Based on current available data, carotid endarterectomy remains the procedure of choice for stroke risk reduction at the cervical carotid bifurcation, provided that certain inclusion and exclusion criteria are met. There exists, however, a group of patients who do not fulfill criteria related to the various studies for carotid occlusive disease, and these patients may be candidates for other procedures to achieve stroke risk reduction such as carotid angioplasty and stenting. This article provides a brief history of angioplasty percutaneous revascularization and discusses patient selection, methodology, and clinical results of carotid angioplasty and stenting.