Carotid endarterectomy (CEA) is a standard surgical procedure used to treat carotid artery stenosis and the associated peri-procedural stroke rate is lower than that associated with carotid artery stenting (CAS). However, the latter is preferred as it is comparatively less invasive. We compared the efficacy of CEA for symptomatic stenosis and CAS for asymptomatic or transient ischemic attack, while considering other factors such as anatomy, renal function, and general status before selecting the final procedure. We operated on 5 lesions using CEA and 14 lesions using CAS. One patient with symptomatic stenosis who was treated using CEA developed symptomatic postoperative stroke. Symptomatic stenosis, vulnerable plaque, and hazardous anastomosis were associated with an increased risk of stenting. A higher location of internal carotid artery stenosis and other anatomical factors should be considered before selecting endarterectomy.