Carotid angioplasty and stenting (CAS) is an alternative technique to restore a normal lumen for patients who are at high risk for adverse effects with carotid endarterectomy (CEA). CAS has been shown to be of benefit to several groups of patients who have carotid disease and who ordinarily are excluded from many CEA trials. Government payors have approved embolic protection devices (EPDs) and stents for the now reimbursable procedure. In fact, the Centers for Medicare and Medicaid Services are now mandating use of the EPDs in CAS to issue payment. The prudent practitioner will carefully select the patients for CAS with EPD and CEA, so that patients will have the safest opportunity to avoid the devastating effects of cerebrovascular accidents.