In the management of vascular disease, there has been an inexorable drive towards less invasive endovascular treatment options. Endovascular treatment of carotid stenosis for stroke is no exception. Several sizeable multicentre trials are running concurrently, which are comparing carotid endarterectomy (CEA), the "gold standard," with the less invasive alternative, carotid stenting (CAS) for low-risk patients with symptomatic carotid stenoses who are considered to be surgical candidates. The endovascular option is in itself a newcomer but state-of-the-art CAS with regards use of all the available technical refinements, to include low-profile monorail dedicated systems with contemporary pharmacological support, is perhaps all but five years old. There is considerable interest from clinicians from a variety of clinical backgrounds and from industry in this technique and, therefore, scope for a contemporary practical guide.