The surgical therapy for severe stenosis of the carotid provides a highly effective prophylaxis for carotid dependent ischemic strokes. After carrying out prospective, randomised studies, evidence based indications for carotid thromboarterectomy are available. Here, it is necesary to take into account the degree of stenosis, an initial clinical symptom (amaurosis fugax, TIA, stroke), and postoperative risk. This can not exceed 3% by asymptomatic and 6% by symptomatic stenoses in order not to endanger the carotid thromboarterectomy. Stenting of carotid stenoses provides a possible alternative to surgery. Until the prospective, randomised studies are completed, carotid stenting offers a clinical possibility which can only be carried out through interdisciplinary cooperation.