OBJECTIVES : This study was conducted to determine the cost-effectiveness of carotid Artery stenting (CAS) versus carotid endarterectomy (CEA) in patients with symptomatic carotid stenosis (more than 50% stenosis) in Korean healthcare system perspective. METHODS: We performed a cost-utility analysis. Costs were estimated from retrospective chart review (CAS=346, CEA=331), health insurance claims data, and other national resources and expressed in 2013 KRW. Transition probabilities were estimated from retrospective chart and systematic review. Health utility index was assessed for general population using Time Trade Off (TTO) with health scenario. We used a Markov model to project 15-year costs and quality-adjusted life years (QALYs) for the 2 treatment groups. RESULTS: In the base case analysis, CAS produced 6.49 QALYs, compared with 6.71 QALYs for CEA. The incremental cost of stenting was 1,691,740 KRW. In the base case analysis, CEA for patients with symptomatic stenosis had a greater benefit than CAS, with lower costs. In subgroup for patients with stenosis more than 70% or patient with over 80 years old, CAS was cost-effective. Sensitivity analyses showed that the major stroke or mortality influenced the results. However the results were consistent with the base analysis. CONCLUSIONS: Under the current circumstances in Korea, CEA was dominated by CEA in symptomatic steonsis. Therefore we concluded that CEA would be cost-effective intervention for carotid stenosis. To be economically competitive, the clinical effectiveness such as mortality and major stroke rates of CAS must be at least equivalent if not less than those of CEA.