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Stroke or ischemia cerebral vascular accident(CVA) is still the 3rd leading cause of deathin the United State．Those patients survived theinitial life threatening event are expectedto battle with neurologic deficits by long termmedical attention and rehabilitation．The sequelwill affect the patients’quality of life，addthe burden on family members，and has asignificantly impact on social economy．Theetiology iS clear，the atherosclerosiS ofinternalcarotid arteries and/or its bifurcation causesstenosiS，the emboli from dislodged plaqueoccludes the distal circulation and results infocal infarction．Several milestone clinicaltrials have clearly demonstrated that it iSbeneficial for tarotid endarterectomy (CEA)orcarotidartery stent (CAS) over medical management inreducing CVA of high-risk patients．