Angioplasty and stent placement have become accepted alternatives to surgery in many vascular territories. The most recent application of percutaneous intervention has been to explore its clinical utility and safety for stroke prevention in carotid arteries. Over the past 8 years, from January 1994 until Nov 2002, we performed 449 elective carotid stent procedures in 426 patients and in 481 vessels. Informed consent was obtained from each patient. Success was achieved in 97.3% of the patients treated. After one month of follow-up, 12 (2.8%) patients experienced stroke or death. After an average of 2.8 ± 1.7 years (range 1 month to 8.8 years) of follow-up, restenosis was found in 11 (2.6%) patients and was treated with balloon angioplasty. Our results, in a predominantly high-risk surgery group of patients, suggest that carotid stent placement is a viable treatment alternative to conventional surgery. It is likely that as the technology continues to evolve, the procedural risks of stroke and death will be minimized by embolic protection devices, making carotid stenting an option for low-risk surgical patients.