A total of 61 percutaneous transluminal angioplasties (PTAs) have been performed in 58 patients with symptomatic severe stenosis of the internal carotid artery in our department since 1990. Forty-nine PTAs were successful (residual stenosis 0–49%). In 5 cases, residual stenosis ranged between 50 and 70%. Seven PTAs failed due to technical reasons. Transient ischemic neurological symptoms occurred in 8 patients. Minor stroke occurred in 2 patients with small hemodynamic infarcts, as revealed by control CT scans. Disabling stroke occurred in 1 patient. The overall neurological complication rate was 18%; the severe complication rate was 1.6%; mortality was 0%. Out of the 53 patients surveyed during the follow-up period (range, 3–48 months; mean, 16 months), there was 1 ipsilateral clinical relapse in a patient with restenosis. Three patients died, 2 of cardiac causes. One patient who refused surgery died of fulminant stroke 3 months after failed PTA. Ultrasonic follow-up in 47 patients (3–48 months; mean, 14 months) revealed asymptomatic restenosis in 2 patients, resulting in a total of 3 cases of restenosis. Carotid PTA seems to be a reasonable alternative to carotid endarterectomy; however, in comparison to carotid surgery, clinical efficacy has yet to be verified by means of randomized clinical trials.