The European Carotid Surgery Trial (ECST) is an ongoing randomised trial of immediate carotid endarterectomy vs non-surgery in symptomatic patients with recent and mild carotid territory ischaemic events. So far it is become clear that the risk of the operation is--in general--worth taking in patients with "severe" stenosis (> 70% of the proximal internal carotid artery diameter) but not in patients with "mild" stenosis (0-29%). The balance of risk vs benefit in patients with "moderate" stenosis (30-69%) is still unclear und recruitment of such patients continues. All patients are still being followed up to assess the durability of any benefit of surgery and to develop prognostic models to predict the risk of ipsilateral ischemic stroke in the no-surgery patients. Also, further studies are being done to investigate the best method of measuring the amount of disease at the carotid bifurcation.