Objective: To report a case of symptomatic internal carotid artery stenosis with a persistent proatlantal artery (PPA), which was treated by carotid artery stenting (CAS) with a fi lter device by means of proximal occlusion of the common carotid artery (CCA) and the external carotid artery (ECA). Case presentation: A 77-year-old man suffering from loss of consciousness was referred to our hospital. Diffusion-weighted image showed a left cerebral infarction and MR angiography revealed a PPA. PPA type 1 was confirmed by 3D-CT angiography and digital subtraction angiography revealed the carotid stenosis, located just proximal to the origin of the PPA in the left internal carotid artery (ICA). Since the stenosis was more than 50% and the patient was elderly, CAS was scheduled. To protect both the ICA and the PPA, a guiding catheter with balloon was employed to occlude the CCA and the ECA simultaneously and to induce blood flow from the PPA to the ICA. Under such conditions, a fi lter device was positioned in the ICA and CAS was done in an orderly manner without any complications. Conclusion: To our knowledge, this is the fi rst reported case of PPA treated by CAS with a fi lter device by proximal occlusion both of CCA and ECA which induced blood fl ow from ICA to PPA.

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