BACKGROUND:  Randomized clinical trials comparing surgery to drug therapy in newly diagnosed carotid stenosis patients, are less relevant today with advancement in drug therapy and increased utilization. Effectiveness of surgery versus current drug therapy in carotid artery stenosis patients hasn`t been studied in real world practice. OBJECTIVES: Compare time to death and other cerebrovascular events in newly diagnosed patients treated with carotid endarterectomy (CEA), carotid stenting (CAS) or drug therapy  METHODS: Patients were identified using the Humana dataset for the years 2007 – 2012.  The date of first diagnosis of carotid stenosis is set as the patient’s index date if followed by a confirmatory carotid duplex ultrasound. An episode of treatment consisted of the 6 months prior to and 12 months post index date. Propensity score matching was employed to match patients using drug therapy to surgery patients. Surgery patients using CAS or CEA were matched separately.  Cox proportional hazards models and logistic regression were used to estimate the impact of surgery versus medications, and surgery type using only surgery patients.  Outcomes were defined as time to death and time to stroke or other cerebrovascular event.   RESULTS: