30% to 60% of all cerebral infarcts. The distribution and severity of atherosclerotic cerebrovascular diseases varies among the patients of different ethnic origins. In Egypt, extracranial carotid atherosclerosis is not common. the majority of ischemic patients enrolled in the study had non-significant extracranial carotid stenosis while in the western countries, the majority of symptomatic patients have significant extracranial carotid Stenosis. Carotid artery stenosis corresponds to 15%-20% of overall ischemic strokes for both symptomatic and asymptomatic (silent) strokes. Carotid artery disease can be characterized as symptomatic if associated with stroke or TIA or as asymptomatic in the absence of such symptoms. Asymptomatic carotid stenosis (ACS) is commonly defined as a ≥ 50% atherosclerotic narrowing of the extracranial internal carotid artery in the absence of retinal or cerebral ischemia in the preceding 6 months. Extracranial atherosclerotic disease (ECAD) can be managed with optimal medical therapy (OMT), carotid endarterectomy (CEA), and carotid artery stenting (CAS). Treatment options largely depend on the presence of symptoms, severity of stenosis, individual factors, efficacy and risk of complications