In summary, a potential equipoise in regard to clinical end-points exists between the two techniques for treatment of carotid artery stenosis. More data are required to compare the cost effectiveness of both procedures. In practice, CAS has become the procedure of choice for treatment of symptomatic carotid stenosis in high-risk surgical patients. Recent approval of CAS by the Centers for Medicare Medicaid Services (9) for this indication provides regulatory endorsement of this change in practice paradigm. Further regulatory assessment for use of CAS in symptomatic low-risk surgical patients and asymptomatic patients is underway. In the interim period, CAS is being offered at institutions for the above-mentioned indications based on physician expertise and patient preference.