Stroke is a major cause of disability and mortality, and a major cause of stroke is carotid artery stenosis. This stenosis is caused by carotid atherosclerotic plaques, the prevention and management of which are the key to avoiding many resultant strokes. The plaque can either embolize to a cerebral artery or build up in a carotid artery, ultimately resulting in thrombosis and total occlusion. Noninvasive testing can now make the diagnosis of carotid stenosis. Medical management with plaque stabilization and platelet inhibition plays a key role in stroke prevention. Carotid endarterectomy and invasive carotid angioplasty stenting are also important for lesions with extensive progression, and patients with a very high overall risk may especially benefit from the latter procedure. A medical-surgical team approach is now greatly contributing to the avoidance of stroke and its devastation.