Backgrounds: Carotid artery stenting (CAS) has been suggested to be a safer and more cost effective alternative to carotid endarterectomy in the management of carotid artery stenosis particularly in high risk patients. Distal embolization of debris during percutaneous CAS may result in neurologic deficit. Distal protection device (DPD) for cerebral protection potentially reduce the risk of embolization and are increasingly employed during the procedure. The purpose of this study is to evaluate the feasibility, safety and short term (30 days) and mid term (6 month) clinical follow up results of elective CAS with or without DPD. Subjects and Methods: Patients (n=59, carotid artery=63) were enrolled and prospectively followed from June 1997 until July 2004. 32 patients(54%) were high risk for carotid endarterectomy. Of these patients, 20 carotid lesions(31.7%) underwent CAS using DPD (PercuSurge GuardWire=13, EPI filter=7) and 43 CAS without DPD. Results: Carotid stenting was performed successfully in all patients. Successful distal protection was achieved 19 cases(95%). Visible aspirated material was shown in 100%(12/12) in CAS with PercuSurge GuardWire and 42.9%(3/7) with EPI filter. 30 days clinical follow up results showed 3 clinical events(7.0%) (2 minor stroke, 1 major hemorrhagic stroke) in non-DPD group and 1 major hemorrhagic stroke and 1 minor stroke in DPD group(p=ns). 2 Hemorrhagic strokes were developed especially in severe stentoic lesion (1 non-DPD group, 1 DPD group) due to hyperperfusion. 30 days embolic neurologic event rates were not different in both groups( 4.7% in non-DPD group, 5% in DPD group, p=ns). 6 month clinical follow up results showed that additional 2 cardiac death occurred in non-DPD group. Conclusions: Carotid stenting with DPD is a safe and feasible procedure with high immediate success rate and low major clinical events during the follow up periods. Considering our initial experience, the use of neuroprotection devices will contribute to the decline in embolic event rates.