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Introduction For carotid artery stenting new dual-layer stents with embolic protection features like the CGuard are available.Aim of Study This study aims to compare the safety and efficacy of the CGuard dual-layer stent with its mesh embolic protection system (EPS) in elective patients with carotid artery stenosis to the Carotid Wallstent as benchmark.Method This retrospective, multicentric study analyzes data from consecutive patients treated with CGuard compared to prior consecutive patients treated with Carotid Wallstent (CWS) – with and without a balloon guiding catheter (BGC), at the same two high-volume centers. Patient demographics, procedural details, clinical complications, early in-stent thrombosis and occlusion rates, and late follow-up restenosis rates were evaluated.Results A total of 428 patients were analysed, 144 with the CGuard, 203 with CWS+BGC and 83 with CWS-BGC, most patients for symptomatic stenoses. No clinical complications were observed in CGuard patients, however the clinical complication rate was 2.96% (6/203) for CWS+BGC and 4.94% (4/83) for CWS-BGC patients (p = 0.052). The in-hospital stent occlusion rate was 0.69% (1/144) for CGuard and 2.1% (6/286) in CWS±BGC patients (p = 0.49). On long-term follow-up (mean 9.9 months) the CGuard demonstrated a comparatively low restenosis rate (6.25%) and retreatment rate (2.1%).Conclusion The CGuard dual-layer stent design appears to be effective and safe for carotid artery stenting with a low risk of periprocedural complications and high technical success rate, while maintaining a low rate of restenosis comparable to the Carotid Wallstent.Conflict of Interest No