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Introduction Up to 15% of stroke patients present with extracranial internal carotid artery occlusion or high-grade stenosis requiring recanalization. Previous studies have shown a high rate of early occlusions with nitinol dual-layer carotid stents, as well as a higher rate of late restenosis compared to single-layer stents.Aim of Study To compare the outcomes of single-layer and dual-layer carotid stents in patients undergoing extracranial internal carotid artery stenting as part of emergent stroke treatment.Method A single-center, retrospective, non-randomized study including 101 patients (median age 68 years; 77.3% male) treated between 2016 and 2023 was conducted. Imaging and clinical follow-up data from patients treated with dual-layer stents (57 patients) were compared with those who received single-layer stents (44 patients).Results The dual-layer stent group exhibited a significantly lower mRS score at 3 months (p=0.015) and lower 3-month mortality (12.3% vs. 34.1%, p=0.008). While a favourable clinical outcome (mRS 0–2) was more common in the dual-layer group (52.6% vs. 34.1%), the difference was not statistically significant (p=0.063). Early occlusions occurred in 2 patients with single-layer stents and 1 with a dual-layer stent. Follow-up revealed 2 occlusions, 2 significant restenoses, and 2 mild restenoses in the dual-layer group, whereas no late occlusions or restenoses were observed in the single-layer group. Differences in stent patency were not significant.Abstract A167 Figure 1Conclusion Stroke patients treated with dual-layer carotid stents demonstrated significantly better clinical outcomes compared to those with single-layer stents. Previously reported higher rates of postprocedural occlusions and late restenoses were not observed in our cohort.Conflict of Interest No