What is the current status of invasive treatment of extracranial carotid artery disease?

Year 2011 sees the publication of U.S. guidelines that recommend expanding indications for carotid artery stenting into "average-risk" patients, whereas guidelines from Australia/New Zealand largely do not. This article reviews the status of invasive treatment of carotid disease and highlights 2 controversial issues that were not really addressed in these guidelines: (1) a lack of emphasis on the importance of intervening rapidly after transient ischemic attack/minor stroke; and (2) why continue to recommend that only "highly selected" asymptomatic patients should undergo intervention when virtually no-one pays any attention?