Background and purpose Surgery is known to have fewer adverse events in patients aged >75 years with carotid stenosis, but some are not candidates due to comorbidity. Stenting using protection devices is the most accepted endovascular technique. Our aim is to show the safety and efficacy of carotid stenting without any protection device in these patients.

Material and methods All patients older than 75 years with carotid stenosis treated in our center between January 2002 and December 2012 were included in this prospective study. All were treated by carotid stenting without protection devices. Angiographic results, neurologic complications and Doppler ultrasound were collected during the procedure and within 30 days.

Results 49 patients were included (mean age 78.2 years, range 75–86). The average degree of stenosis was 88.2%. During the procedure there were two cases of transient ischemic attack and one intraparenchymal hemorrhage. At 30 days there was a non-disabling stroke. The combined rate of disabling stroke plus myocardial infarction plus death was 6% at 30 days and the rate of any stroke was 4% during the procedure and 2% at 30 days.

Conclusions Endovascular treatment of carotid stenosis without protection devices in symptomatic patients aged >75 years is an alternative to endovascular treatment with protection devices. Complications and mortality rates are similar to studies that used protection devices in lower risk patients.