There are many different processes that can cause carotid artery disease, but by far the most overwhelmingly common is atherosclerosis, which is the same kind of biologic process that affects heart arteries, or might affect leg arteries, or other arteries throughout the body. Atherosclerosis is a process whereby a blockage occurs, and that blockage in the carotid artery can predispose someone to stroke. And so if we find the blockage in the carotid artery, the narrowing, itÕs called a stenosis. If we find that stenosis, and weÕre able to intervene, we reduce patientÕs long-term risk of stroke. Patients who are most likely to suffer from carotid artery disease are patients who have risk factors for atherosclerosis; high blood pressure, coronary artery disease, high cholesterol, family history of having artery problems. Generally, patients have the inability to move or feel their arm or leg. They may be unable to speak. They may have facial drooping. They also may have a condition of fleeting blindness. Those are all signs and symptoms of carotid artery disease that should be discussed with a doctor right away. Carotid artery disease can be treated in one of generally three ways; medical management, in which patients are put on antiplatelet therapy, which is aspirin, and we have some newer antiplatelet agents. Carotid artery stenosis has traditionally been treated in patients with significant stenosis by whatÕs called carotid endarterectomy. Clamps are placed on the carotid artery to stop the blood flowing through the carotid artery, and the plaque, or atherosclerotic build-up, is cleaned from the carotid artery. ThatÕs what we have the most experience with. More recently with endoluminal, or whatÕs called endovascular or less invasive techniques, carotid artery stenting has been performed. ThereÕs a newer treatment that involves carotid stenting, but it involves operating on the carotid artery in a way thatÕs less invasive. The outcomes of this newer, whatÕs called transcervical carotid artery stenting, or TCAR, are very similar to results of carotid endarterectomy, the traditional operation. And this is a novel way that the carotid artery is now treated in patients who might have a difficult operation, but now can have a less invasive operation.