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Surgical and endovascular procedures are established treatments for extracranial stenoses of the internal carotid artery (ICA) according to current guidelines. Revascularization is generally recommended for symptomatic ICA stenoses between 50% and 99%. For asymptomatic stenoses, optimal medical therapy is the primary focus; revascularization should be considered for stenoses between 60% and 99%, depending on the individual risk. The choice between endarterectomy (CEA) and carotid artery stent implantation (CAS) is made by an interdisciplinary team, considering patient- and anatomy-specific factors. Interventional therapy is well-established; however, studies show an increased incidence of minor strokes and transient ischemic attacks (TIAs), which is why patient selection and embolic protection are becoming increasingly important in the field of endovascular revascularization. Technological advancements, such as innovative double-layer stents for improved plaque coverage, increase the safety of the procedure, and reduce the peri-procedural stroke rate. Anatomical features are essential for successful treatment when selecting devices and planning procedures.