Carotid angioplasty and stenting (CAS) has developed as an alternative for carotid endarterectomy (CEA) for the treatment of carotid artery disease. As technology has improved, procedural risks have declined and are approaching those reported for CEA. The benefits and durability of CAS compared with CEA are still being studied in ongoing randomised controlled trials. This review discusses the evolution of techniques and materials and the results of randomised trials and observational studies.