Background and Objectives : The purpose of this study is to evaluate the feasibility, safety and short (30 days), mid-term (6 months, 1 year) clinical follow up result of elective carotid artery stenting with or without distal protection device in patients with carotid artery stenosis. Subjects and methods: Patients were enrolled and prospectively followed from June 1997 until June 2007. Neuroprotection devices were introduced in September 2002. patient demographics, procedural details, 30 day events and 6month follow up data were collected. 58.1% were asymptomatic and 48.9% were symptomatic. Results: 87 patients underwent carotid stenting of 93 arteries. The mean age of the patients was 68 짹 7 years, 69% were male. 62.1% of patients had concomitant coronary artery disease. 6.9% had bilateral carotid artery stenting. 46 cases (49.5%) of patients had their procedure performed using a neuroprotection device (PercusurgeGuardwire: 13 cases, EPI filter: 33 cases). Procedural success was achieved in 100% of CASs without protection and 96% of CASs with distal protection. At 30 days, 6 months and 1 year cumulative events rates of CASs were 8.6%, 10.8% and 12.9%. The cumulative events rates during 30 days, 6 months and 1year were not significantly different between non-protection and protection groups (6.4% vs. 10.9%, 10.6% vs. 10.9% and 14.9% vs. 10.9%, respectively, all p=NS,). Of interest, 2 hemorrhagic strokes were developed after CASs due to hyperperfusion to the brain. The majorities of events after 30 days of CASs were cardiac deaths. Conclusions: Carotid stenting is a safe and feasible procedure with high immediate success rate and acceptable low major neurological clinical events during the follow up periods. However, special attention was needed to prevent hemorrhagic stroke and cardiac events after CASs. Further, the use of neuroprotection devices will contribute to the decline in embolic event rates.