Carotid artery stenosis (CS) is a critical diagnosis linked to ischemic stroke, a leading cause of morbidity and mortality, affecting about 4% of the general population. Risk factors for CS include age, hypertension, dyslipidemia, diabetes, and smoking, with poly vascular disease seen in 45% of patients with known atherosclerotic disease. Early recognition and management of CS are crucial to prevent stroke by utilizing imaging modalities like Duplex ultrasound (DUS). Management of CS involves complex decision-making that balances the risks and benefits of intervention against the developing diagnostic and therapeutic modalities. This narrative review aims to review and examine the current guidelines for clinicians' approach to CS.