The results of this preliminary study indicate that the transcervical approach with flow reversal during the insertion of the protecting filter allows CAS with minimal interruption of cerebral circulation and is simple and safe in patients unsuitable for CEA and transfemoral CAS for anatomic reasons. Further research with randomization and with pre-procedure and post-procedure diffusion-weighted magnetic resonance imaging (DW-MRI) is required in order to expand the indications of this method.