Stroke has an immense burden on public health not only due to its high mortality but also because many of the survivors are left with a lifelong disability decreasing their quality of life. The overall incidence of stroke has declined substantially during the 21st century owing to better medical treatment and also improved public recognition of stroke symptoms, but there still is room to decrease its burden. Based on etiology, extracranial internal carotid artery stenosis comprises a large proportion of these preventable strokes and carotid reconstruction, either through carotid endarterectomy (CEA) or carotid artery stenting (CAS) has been established as an effective preventive intervention, especially in symptomatic patients. Carotid artery stenosis is often detected in asymptomatic patients but their treatment depends on various factors such as the severity of stenosis and plaque characteristics. The choice between CEA and CAS depends on a variety of factors such as age, comorbidities, and patient anatomy to name a few. There are multiple clinical scenarios such as the presence of contralateral carotid occlusion, bilateral carotid artery stenosis and even patients with concomitant coronary artery disease where the ideal management of the ipsilateral carotid artery stenosis is unclear. Many of the current guidelines do not have strong evidence on how to manage these coexisting situations and there is a definite need for future studies to bring forth new evidence to ensure the best outcomes for such patients.