This chapter mainly focuses on surgical techniques (carotid endarterectomy) and endovascular embolization (carotid stenting) used to treat atherosclerotic disease and vertebral artery disease. The standard methods used for diagnosis of extracranial vertebral atherosclerosis are catheter angiography, abdominal and pelvic computed tomographic or magnetic resonance angiography. Carotid endarterectomy (CEA) is done to prevent stroke caused by carotid atherosclerosis. The fundamental steps of CEA involve making an arteriotomy followed by plaque dissection and arteriotomy closure. Carotid stenting is typically performed using femoral artery access. Carotid stenting can be performed using many different stents and embolic protection systems. CEA for atherosclerotic disease has been shown in multiple large-scale trials to be beneficial in stroke prevention. Based on the history and evaluation of patient the treatment option is chosen.