Carotid angioplasty and stenting (CAS) is a well established technique. CAS indications currently still limited are yet evolving. The choice of the access is defined by the risk factors of the patient among whom ''the vascular anatomy'' is essential. The authors will focus here on the accesses, their advantages and their drawbacks. They made a retrospective study relating 314 patients treated by CAS. No significant difference in term of morbidity or mortality between the cervical or femoral access was found but a clear tendency in favor of the cervical access which avoids the arch manipulations. It can be concluded that various access offer better options for CAS and must be discussed depending on the patient's anatomy and risks factors.