Carotid percutaneous transluminal angioplasty, with or without stent implantation, is becoming another therapeutic option for carotid revascularization. To evaluate the feasibility and effectiveness of the technique, from October of 1995 to March of 1997, we performed 24 percutaneous transluminal angioplasty procedures in 22 patients with severe extracranial carotid artery stenosis. Three common carotid and 21 internal carotid arteries were treated, and 19 procedures included stent implantation using nonarticulated PALMAZ stents (P154 and P204). Twelve patients were asymptomatic and 10 patients were symptomatic; 2 of the symptomatic patients had complete obstruction of the internal carotid artery that was successfully recanalized. Technical and angiographic success was achieved in 23 of 24 procedures, with the carotid artery obstruction diminishing from 85.6% +/- 8.5% to 5.7% +/- 3.2% (P < 0.001). Average stenosis length was 12.5 +/- 3.1 mm, and mean time of carotid occlusion during balloon inflation was 11.5 +/- 2.5 seconds. Three patients experienced transitory seizures during the procedure prior to dilation, 1 patient had a minor stroke with complete recovery within 72 hours, and 1 patient had a major stroke and died 45 days after the procedure. Clinical follow-up was achieved in all patients (mean, 10.5 +/- 7.2 months) and angiographic follow-up in 16 patients (mean, 6.3 +/- 1.2 months). The results obtained in this initial experience provide adequate support to continue further evaluation of this new therapeutic strategy.