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Since the first carotid angioplasty that was performed in 1980, this technique has undergone tremendous modifications and improvements. Stents for the carotid artery were utilized in the early 1990s, and emboli protection devices were introduced about 2000. Advances in equipment (guidewires, catheters, balloons, stents, and emboli p- tection devices) have improved the technical success and safety of carotid stenting. With the recent SAPPHIRE publication revealing non-inferiority of carotid stenting compared with carotid endarterectomy for high-risk surgical patients, this percutaneous procedure is now considered a viable alternative to endarterectomy for these patients. In fact, the FDA has approved carotid stenting for high-risk patients using the AccuLink stent and AccuNet device (Guidant Corporation, Santa Clara, CA) in August 2004, and the TM TM Xact and EmboShield system (Abbott Vascular Devices, Redwood City, CA) in September 2005. Increasing numbers of carotid stenting are being performed around the world, and established interventionalists and trainees alike are seeking to be instructed in performing this meticulous procedure. Unfortunately, there are insufficient well-established peri- eral vascular training programs to meet this increasing demand. Only a small proportion of current trainees are enrolled in fellowship programs with dedicated carotid interv- tional training that perform high-volume extracranial carotid stenting; even fewer are enrolled in programs that also partake in intracranial and acute stroke interventions. In North America, this shortage of dedicated training programs leaves interested interv- tionalists pursuing carotid stent training through short educational courses, and often haphazard and limited hands-on  experience in other institutions.