OBJECTIVE: The early management of patients with acute symptoms due to carotid stenosis remains a subject of debate. Carotid endarterectomy (CEA) has been shown to reduce the risk of stroke in patients with symptomatic extracranial carotid artery stenosis. Carotid artery stenting (CAS) has recently emerged as an alternative to CEA for the primary and secondary prevention of stroke in patients who are at a high risk for complications from surgery. The aim of this study is to evaluate and analyze the clinical outcome of symptomatic high-risk patients with carotid stenosis that was treated with early CAS in a single stroke center. METHODS: From January 2008 to October 2009, we retrospectively analyzed 75 symptomatic high-risk carotid stenosis patients who had been admitted to the stroke center of our neurosurgical department and who were treated with early CAS. Twenty-five patients had transient ischemic attack (TIA) and 50 patients had minor or major stroke and all of them were at a high medical and surgical risk for carotid endarterectomy. They were treated with early CAS as soon as possible (treatment was done within 2 weeks from the onset of symptoms). RESULTS: At three months, 15 patients (20%) in the TIA and stroke group experienced an improvement in their initial neurologic deficit (a decreased modified Rankin scale greater than 2), while in 59 patients (78.4%) the deficit remained stable, and only one patient had a neurological impairment. CONCLUSION: Our data indicates that urgent assessment and early initiation of a combination of existing preventive treatments can reduce the risk of early recurrent stroke after TIA and minor or major stroke in the symptomatic high-risk patients with carotid stenosis.