In the past 3 years, there have been significant developments in the field of carotid revascularization, including: 1) the results of a large primary stroke prevention trial; 2) the emergence of novel platforms for emboli protection; 3) improved characterization of the high-risk carotid artery stent (CAS) patient; 4) completion of several very large post-market surveillance (PMS) trials of CAS in high-surgical-risk patients; and 5) the completion of 4 large randomized controlled trials comparing CAS with carotid endarterectomy in average-risk patients. The purpose of this review is to update the current status of revascularization therapies to reduce stroke in patients with extracranial carotid artery disease with a focus on the most recent developments regarding the role of CAS. (J Am Coll Cardiol Intv 2010;3: 467-74) (C) 2010 by the American College of Cardiology Foundation