In the past, the risk of stroke or death from symptomatic carotid stenosis was very high, approximately 10% per year. Historical guidelines have recommended that if surgery or stenting can be performed with a risk of stroke or death of less than 6%, it was indicated. However, since 2005, with much better medical therapy, the risk has declined so much that it has been suggested that for some patients with symptomatic carotid stenosis, intensive medical therapy would be reasonable.1 The 6% benchmark for risk of intervention in patients with symptomatic carotid stenosis is now obsolete.