Carotid endarterectomy (CEA) has become an established procedure for the treatment of patients with transient ischemic attacks (TIAs) associated with severe stenosis and/or ulceration in the carotid artery and is the best option in symptomatic patients with 70% to 99% carotid artery stenosis. Percutaneous transluminal angioplasty (PTA) is being extensively and routinely applied to treat arteriosclerotic lesions in pelvic, leg, coronary, and renal arteries. PTA has not been widely accepted for the treatment of supra-aortic lesions, especially carotid artery stenosis, because of the danger of cerebral embolism. More recent technical developments, however, have made PTA feasible under restricted conditions.1Emergency CEA and PTA of carotid stenoses are still controversial. The pros and cons of emergency surgery and PTA for acute stroke, crescendo TIA, and acute carotid dissection are reviewed.