Stroke is the leading cause of long-term major disability in developed countries, although several improvements could be achieved in acute stroke therapy (e. g. thrombolysis, stroke-unit treatment, optimized early rehabilitation strategies). Therefore, primary prevention is essential to reduce the burden of stroke. 10 -20 % of all cerebral ischemias are caused due to stenosis or occlusion of the extracranial carotid arteries. This review summarizes the indications, diagnostics as well as the actual data for a medical, endovascular or operative treatment of asymptomatic carotid stenosis.