25% of stroke cases. Angioplasty and stenting are minimally invasive techniques and are gaining wider acceptance. Angioplasty has been tempered by the increased risk of stroke resulting from distal embolization, vessel dissection, or arterial rupture. Stenting has been shown to increase the safety and efficacy of balloon angioplasty. Stent technology has evolved and new stents that have more flexibility and radial force were introduced. Thrombolytic therapy for the occlusion of the ICA should be started within 6 hours after the onset of stroke. Intraarterial thrombolysis offers early recanalization with relatively low dose of t-PA. The direct application of thrombolytic drug allows a lower total dose, may reduce systemic effects and may reduce time to recanalization. Intracranial thrombolysis has been performed using direct thrombolysis. Intra-arterial delivery of highly concentrated drug and mechanical disruption of the thrombus by the catheter and guidewire may have advantages over the intravenous administration. Reopening of the occluded carotid arteries is controversial, and neither surgical nor endovascular treatment of complete ICA occlusion has become standard practice. For patients with chronic occlusions, successful reopening of the ICA is highly unlikely. However, in acute occlusion, emergency surgery to perform a thromboendarterectomy using Fogarty catheter to pull thrombus can yield good results. Bellon et al have used a device to open occluded ICA to reach MCA occlusion to obtain flow. PTA and stenting of the carotid arteries are associated with an obligatory release of particulate debris into the distal cerebral circulation. Although most of the emboli are small and do not cause symptomatic neurological deficit, some may be large enough to result in stroke. For this reason cerebral protection with occlusive balloon, filter, flow-reversal is used to decrease the risk of distal embolizastion during PTA and stenting.