Means for endovascular therapy have radically altered the treatment paradigm for occlusive lesions of the aortic arch vessels. Diagnosis of these problems by noninvasive means is becoming increasingly more common, allowing invasive evaluation and treatment to occur simultaneously. Most of these lesions are atherosclerotic and occur at the vessel origin. These types of lesions tend to be heavily calcified and unresponsive to simple angioplasty alone. Angioplasty in conjunction with stenting offers an additional therapeutic alternative for lesions affecting these vessels. A brief review of the alternatives and techniques for both open surgical and endovascular treatment of these abnormalities will allow the physician caring for patients with these problems to offer patients the best treatment option available.