Several surgical procedures have been tries as alternatives to carotid endarterectomy (CEA) in the treatment of carotid artery occlusive disease. CEA has been long established as the technique of choice for the surgical repair of carotid stenoses, however, it may be technically demanding in unfavorable anatomical conditions. Some recurrent severe restenoses may be not amenable to simple endarterectomy and patching.Eversion endarterectomy is an alternative to conventional CEA that has the advantages of patch angioplasty in preventing restenosis without the potential risks of prolonged cerebral ischemia or the need to use a patch. Percutaneaus angioplasty with stenting (PTAS) are promising but not safer than (CEA) for the treatment of carotid artery stenosis long term follow-up. Is needed to determine the ultimate durability of this new Technique (PTA) with stenting may be an alternative for the Treatment of carotid bifurcation lesios in selective high-risk surgical patients. Carotid artery stenting is feasible and can be performed even in high risk patient associated with a low restenosis rate. Neurological outcomes after carotid stenting protected with the Neuro-shield filter compared to unprotected stenting. Filter-related complications are well tolerated. Neuroprotection device have the potential to reduce the procedural neurological event rate.