In the management of vascular disease, there has been an inexorable drive towards less invasive endovascular treatments. This has substantially altered the attitudes of patients, clinicians and health care providers. Endovascular treatment of carotid stenosis for stroke is no exception. Several trials are running concurrently; these are comparing carotid endarterectomy (CEA) with the less invasive alternative, carotid stenting (CAS). There is already evidence that CAS may be preferable in certain patient populations i.e. those deemed to be at high surgical risk. Furthermore both procedures have comparable benefits in terms of survival free of ipsilateral stroke between three to five years post-procedure. State-of-the-art CAS (with regards use of all available technical refinements) is all but five years old. There is considerable interest from clinicians from a variety of clinical backgrounds and from industry in this technique and, therefore, scope for a contemporary practical guide.