Cerebrovascular accident (CVA) is the third leading cause of death in North America and Europe, accounting for approximately 10-12% of all deaths.w1 CVA may have several aetiologies but is generally characterised as being either thrombotic or haemorrhagic in origin. The thrombotic causes of CVA are multiple and can be divided into large vessel occlusion, small vessel occlusion, and embolisation. Large vessel occlusion from atherothrombosis of the carotid system is responsible for approximately 25% of those afflicted by a CVA. The treatment of carotid atherothrombosis is evolving and involves risk factor management and in selected patients may warrant either surgical carotid endarterectomy or percutaneous carotid stenting. This is a review of the current understanding of carotid atherothrombosis and data regarding percutaneous approaches for those with this condition.