OBJECTIVES: Carotid artery stenosis is an important risk factor for, and is also believed to cause as much as 20% all strokes. Several surgical therapies are available including carotid endarterectomy (CEA) and carotid angioplasty with stenting (CAS). Although there appear to be benefits to adopting widespread use of CAS, numerous parties have expressed concern about its safety. A number of large protected CAS (PCAS) trials are underway, however, it will be 3 to 5 years until these results are released. In the interim, PCAS continues to be employed. Since numerous PCAS studies were recently published, the aim of this systematic review was to answer the question: based on the most recent evidence, what is the efficacy of protected carotid angioplasty with stenting (PCAS)? METHODS: Electronic, manual and bibliographic searches of Medline, PreMedline, Healthstar/OVID, EMBase, PubMed were conducted. RESULTS: Over 400 articles were identified, of which 18 studies met the inclusion criteria. The technical complication rate of PCAS was 3.3%, the overall adverse event rate was 3.1% and the 30-day mortality rate was 1.2%. A chi-square analysis of the adverse event rates revealed no clear relationship between the study group and proportion of adverse events among all 18 studies (×2 = 14.6, p > 0.10). Multiple sensitivity analyses were conducted; however, no relationship between the study group and proportion of adverse events resulted (×2 = 11.2, p > 0.10). CONCLUSION: Although practitioners await stronger evidence, this study demonstrates the relatively low rates of adverse events in PCAS relative to CAS alone and the warranted use of PCAS.