It behooves the general surgeon to possess good knowledge of the atherosclerotic disease of the carotid arteries, its epidemiologic impact, clinical manifestations, diagnostic methods, therapeutic approach, and the indications for surgery based on results of controlled prospective studies both in symptomatic and asymptomatic patients. Carotid endarterectomy remains the standard therapy for carotid stenosis because of its low perioperative morbidity and mortality and the significant reduction of ipsilateral and contralateral cerebrovascular disease, both in the short and late postoperative follow-up. Endovascular therapy by angioplasty and placement of stents appears promising, but it still does not replace carotid endarterectomy, and currently is indicated only in patients of high anesthetic or surgical risk.