In this review of the literature the goal was to determine the frequency and relevance of hemodynamic instability after carotid artery (CA) angioplasty and stent placement. Hemodynamic instability after CA angioplasty and stent placement is a well-recognized phenomenon that occurs in 29 to 51% of patients undergoing the procedure. In some patients this problem is severe enough to warrant treatment with vasopressor agents. Features observed on clinical and angiographic evaluation can help clinicians identify patients who are at risk. Hemodynamic fluctuations encountered as a result of CA angioplasty and stent placement may have adverse clinical consequences, including a higher incidence of myocardial infarction and stroke. Proposed measures to prevent this complication include prophylactic placement of transvenous pacemakers or pretreatment with atropine. Unfortunately, no randomized trials are currently available to assess the efficacy of these approaches. Hemodynamic instability is a common finding after CA angioplasty and stent placement. Clinicians can predict which patients are at risk by considering angiographic and clinical features.