Objective To assess the value of brain protection measures in carotid angioplasty and stenting(CAS)for carotid stenosis and contralateral occlusion in reducing the perioperative cerebral isehemic events.Methods Twelve patients undergoing CAS in our department were included in this analysis.All the patients received balloon occlusion test(BOT)of the carotid artery preoperatively.Two patients who were intolerant to BOT received extracranial-intracranial vascular anastomosis,and another 2 patients relatively intolerant to BOT received CAS under general anesthesia.The brain protection measures including reduction of the cerebral blood flow occlusion time and prophylactic management of thrombosis were administered to prevent the ischemic events.The efficacy of the brain protection measures was evaluated by diffusion-weighted imaging(DWI)and observation of the clinical ischemic neurological symptoms.Results Three patients suffered transient ischemic attacks(TIAs),1 patient had temporary vision loss,and 1 had permanent ischemic neurological deficits after the operation.DWI yielded positive results in 50% of the patients after the operation,characterized mostly by small local lesions of 1-2 ram.Eight patients presented with carotid artery dilation by over 90%,and 4 by 70% to 90% after the operation.Conclusion The brain protection measures including precise preoperative evaluation of the ischemic tolerance and blood flow and reduction of cerebral blood flow occlusion time and prevention of thrombosis during the operation can effectively reduce the incidence of perioperative ischemic events in high-risk patients with carotid stenosis and contralateral occlusion.