The article is dedicated to the problem concerning the choice of treatment for carotid stenoses, which is becoming yet increasingly important due to revision of the therapeutic approaches to management of stenoses of the extracranial portions of the carotid arteries over the last two decades. Presented herein is a review of the published studies and discussed are possible causes of contradictory findings obtained therein. Separately considered is an economic component of the problem involved, underlining the lack of commonly accepted and expressly defined recommendations on treatment decisions regarding revascularization of the carotid arteries. A conclusion is drawn on the necessity of developing a scientifically based therapeutic algorithm.