Stroke is one of the leading causes of morbidity and mortality of adults in the United States. Carotid artery disease, most commonly from atherosclerosis, causes approximately 10–20% of strokes, being a large component contributing to this deadly condition. Carotid endarterectomy is considered the gold standard for management of carotid artery stenosis. With evolving technologies, carotid stenting is now considered an alternative to endarterectomy in patients at high surgical risk. Both endarterectomy procedures and stenting have been proven to be effective interventions to prevent stroke. Examinees should be able to differentiate carotid disease symptoms from rare “posterior” ischemia originating from the vertebrobasilar arterial system.