Patients with carotid stenosis are at high risk of stroke and acute ischemic events in other vascular territories and require intensive medical treatment. This chapter reviews the evidence for specific medical treatments in patients with carotid stenosis. Antiplatelet agents, cholesterol-lowering drugs and blood-pressure-lowering drugs should be considered in all patients with carotid stenosis. The use of drug combinations has the theoretical advantage of inhibiting platelet activity through more than one pharmacological mechanism, hence potentially conferring a greater antiplatelet effect. Loss of the normal autoregulatory capacity of the cerebral circulation such that cerebral blood flow is directly dependent on perfusion pressure, is common and there has been concern that blood pressure lowering may reduce cerebral perfusion and increase the risk of stroke. Intima-media thickness (IMT) is correlated with the presence of cardiovascular risk factors and possibly with the future risk of vascular events including stroke and myocardial infarction.