Objective To investigate the efficacy and safety of carotid angioplasty and stenting for carotid stenosis in high-risk symptomatic NASCET-ineligible patients. Methods Twenty patients with symptomatic carotid stenosis at high risk ineligible for NASCET were treated with carotid angioplasty and stenting,12 of them were men,and 8 wre women,the patients ranged in age from 62 to76 years (mean age,69 years). Eleven patients had transient ischemic attack and 9 had cerebral infarction. Digital subtraction angiography showed that the degree of carotid stenosis in all patients was ＞ 70% (NASCET criteria). Among them,9 patients had unilateral carotid artery severe stenosis (2 had restenosis after endarterectomy),6 had bilateral carotid artery severe stenosis,5 had unilateral carotid artery occlusion with contralateral severe sentoses (1 had undergone cervical radiotherapy for nasopharyngeal carcinoma). The embolic protection devices,predilation,and self-expandable stents were used in all patients. Results The success rate of the procedure was 100%. The residual stenosis rate was ＜ 30%. The different levels of a transient decline in heart rates and blood pressure occurred in all the patients during the procedure. One patient was complicated with microembolic embolism. No ischemic stroke occurred in the remaining patients in the periprocedure. The postoperative examination with carotid ultrasound showed that the stenoses were improved significantly. No ipsilateral ischemic stroke and coronary ischemic events were observed at 1 and 3 months follow-up after the procedures. Conclusions Carotid artery stenting is less invasive,and the perioperative complications are fewer,The treatment of symptomatic carotid stenosis with high surgical risks is safe and effective.