Carotid artery stenting is rapidly emerging as a minimally invasive alternative to carotid endarterectomy for the treatment of cervical carotid artery occlusive disease and stroke prevention. Periprocedural stroke risk still remains a concern despite improvements in technique and equipment. We will review technical, clinical and radiographic factors associated with an increased risk of stroke during carotid artery stenting. The primary focus will be on technical proficiency of the interventionalist, patient comorbid conditions (i.e., diabetes, coronary artery disease, renal failure and advanced age) and equipment (i.e., embolic protection systems and stent designs) that have been identified in the literature as predictors of poorer outcomes.