BACKGROUND AND OBJECTIVES: Distal filter devices (DFDs) are known to reduce the occurrence of embolic events by capturing embolic debris and thereby preventing intracranial embolization during carotid artery stenting (CAS). However, there are few reports addressing DFD use in CAS procedures. Therefore, we evaluated the technical feasibility and clinical outcomes associated with DFD use in all CAS procedures. SUBJECTS AND METHODS: Between June 2004 and June 2008, all CAS procedures performed at our center were completed with DFD protection. We recorded periprocedural data and watched for new neurologic abnormalities for 24 hours after the procedure. One-month clinical outcomes were also evaluated. RESULTS: A total of 100 carotid lesions in 94 patients (age 68+/-8 years; 79 men) were treated with percutaneous stenting using DFDs (FilterWire EZ(TM), Boston Scientific Co, US). DFD application was successful in all procedures. Periprocedural strokes occurred in five procedures (one major, one minor, and three transient ischemic attacks). The one-month rates of stroke and death were 6% and 2%, respectively. Difficult filter placement occurred in two procedures due to tight stenosis and severe common carotid artery (CCA)-to-internal carotid artery (ICA) angulation. Difficult stent delivery occurred in three instances: one due to severe lesion calcification and two due to proximal tortuosity. The retriever failed to acquire the filter in nine procedures. Four of nine retrieval difficulties were related to severe CCA-ICA angulation. CONCLUSION: DFD use was successful in all CAS procedures, was relatively safe, and had few periprocedural complications.