Percutaneous transluminal angioplasty with stenting for high-grade carotid stenosis has been recently come into use. However, distal embolic events remain a problem with this procedure compared to results with established carotid endarterectomy. To counteract such problems, various blocking balloon system such as a simple distal blocking balloon system or a thrombi catching system have been used in some instances. This time, a double-balloon system was used as a proximal blocking system during predilation, and an existing distal blocking system was used during practical carotid stenting. These systems were applied to six cases. In addition, we used a modified conventional blood transfusion system for filtration and retrieval of the aspirated blood. Compared with the simple distal blocking balloon system, occurrence of distal emboli could be reduced with our new combined method although the number of cases is too small to reach any definite conclusions.