This article reviews the disease process of carotid artery stenosis, its symptomatology, and prognosis for progression to ischemic stroke. Indications for both medical and surgical treatment are reviewed as is criteria for surgical categorization as specified by the American Heart Association guidelines for carotid endarterectomy. Although diagnostic testing, medical treatment and alternative therapy options of angioplasty, stenting and thrombolysis are presented, a thorough overview of the surgical procedure of carotid endarterectomy is the major focus of discussion, as it remains the "gold standard" of treatment for severe carotid artery stenosis.