TIAs in carotid territory usually are associated with severe stenosis, but may be associated with moderate stenosis and ulcerative plaque at the carotid bifurcation in the neck. With carotid symptoms, especially in association with a carotid bruit or decreased carotid pulse, noninvasive carotid evaluation using carotid duplex ultrasound, CT angiography, or magnetic resonance angiography (MRA) are performed to define the vascular anatomy, and to determine whether the patient is a candidate for carotid endarterectomy. Recently stenting of the carotids has emerged, but is still reserved for medically unstable patients with symptomatic disease. Occasionally, traditional cerebral arteriography may be necessary if the vascular anatomy is not well imaged with noninvasive techniques. Remember, the carotid must have a 75% cross-sectional area reduction before the blood flow is decreased significantly. If the TIA is caused by emboli from an ulcerated plaque, stenosis need not be present. There are patients who have an occluded internal carotid with no symptoms at all. Moreover, patients may have a carotid bruit without stenosis and stenosis without a bruit.