Carotid disease is like any other atherosclerotic manifestation, a condition, which may induce thrombosis, in this case with subsequent cerebral ischemia. Carotid endarterectomy has proven effective in preventing ipsilateral stroke, however, the studies providing the evidence were conducted before the use of statins, newer antiplatelet and antihypertensive drugs, and at a time when less emphasis was on lifestyle modification. Therefore, it is likely that, not only would all patients with carotid stenosis benefit from modern medical treatment, in addition, some patients could have similar risk reduction to that of endarterectomy, were these effective preventive drugs used systematically, as recommended, in this patient group. This article reviews the evidence that is available concerning medical therapy for patients with carotid stenosis, with special emphasis on antiplatelet and statin therapy. An example on how this treatment may be organised is given.