A less invasive option to carotid endarterectomy for the prevention of ischemic stroke in patients with carotid artery stenosis is carotid artery stenting (CAS). The safety and effectiveness of CAS have been enhanced over the last 20 years by important developments in peri-procedural management, patient selection criteria, embolic protection systems, and device technology. Transaortic artery revascularization (TCAR), next-generation embolic protection devices, and imaging-guided procedural techniques are some of the recent innovations that are examined in this thorough review, which also highlights the evolution of carotid stent design and discusses current evidence from major clinical trials. It also looks at patient outcomes, how to handle complications, and how CAS will develop in contemporary vascular practice.