Ischemic stroke represents a major health hazard around the world, which has a severe impact on society and the health-care systems. Roughly, 15% of all strokes can be attributed to significant atherosclerotic disease of the carotid arteries. Some patients presenting with disabling strokes for the first time cannot benefit from carotid revascularization having lost the opportunity of prevention. We know that all symptomatic patients were once asymptomatic. Hence, after identifying high risk carotid plaques and patient’s characteristics suitable for interventions, they should be offered carotid revascularization at specialized centers (with low perioperative stroke and death rates) to prevent stroke and cognitive function decline in long term