As carotid artery stenting (CAS) is now approved for use in both high surgical risk patients with symptomatic carotid artery occlusive disease and in standard risk, asymptomatic patients, the technical aspects of performing this procedure safely must be taught and disseminated. The consequences of embolization or thrombosis to the cerebral vasculature can be much more devastating than in other vascular beds treated via endovascular means. Therefore, the delineation of a safe and effective approach to CAS is evident, and attention to meticulous patient selection and procedural performance is extremely important. Even minor technical errors may lead to complications that significantly increase morbidity and mortality, the most feared of which is acute stroke. By applying appropriate patient selection and adhering to a best practice approach in the conduct of the procedure, complications can be avoided and morbidity and mortality minimized. In addition, identifying salvage techniques for potential procedural complications can decrease potential morbidity and mortality. This chapter reviews our best practice approach to CAS and hopefully adds to your knowledge, perspective, and clinical approach to patients with carotid occlusive disease.