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Introduction Distal embolization remains a major procedural risk during carotid artery stenting (CAS) and is a central target of embolic protection strategies. Conventional distal filter devices capture plaque debris while maintaining antegrade flow but may increase procedural complexity. The Neuroguard IEP™ System is a novel 3-in-1 platform integrating a carotid stent, post-dilation balloon, and fine-mesh embolic protection filter, with the potential to reduce device exchanges and streamline workflow. The incremental clinical benefit of adding a separate distal embolic protection device to this integrated system remains uncertain. We evaluated the comparative effectiveness of Neuroguard IEP™ used alone versus with adjunct distal filters on embolic outcomes and procedural efficiency.Methods We conducted a retrospective single-center analysis of 22 patients presenting with symptomatic lateralizing stroke-like deficits, with or without acute ischemic changes on MRI, who underwent unilateral culprit carotid artery stenting at a Comprehensive Stroke Center between July 2025 and February 2026. Patients were treated with the Neuroguard IEP™ system either alone or in combination with an adjunct distal embolic protection device at operator discretion. Clinical and procedural data were analyzed to assess embolic outcomes and workflow efficiency. Embolic outcomes were evaluated using pre- and postprocedural NIHSS scores. Procedural time was defined as the interval from deployment to capture of the Spider/EZ filter; for the Neuroguard-only group, it was defined as the interval from filter reduction to stent delivery system removal, corresponding to proximal balloon deflation and blood return from the balloon guide catheter.Results The cohort included 22 patients (mean age 70 years; 36% female), all symptomatic prior to intervention, with a median preprocedural NIHSS of 2 and a mean symptom duration of 13 days. Adjunct distal embolic protection was used with Neuroguard in 64% of cases, while Neuroguard alone was used in 36%. Technical success was achieved in 100% of procedures without residual high-grade stenosis. One patient experienced worsening NIHSS (18 to 24) in the setting of a large acute left intraparenchymal hemorrhage requiring decompressive hemicraniectomy and subsequent development of right MCA-ACA watershed infarcts, prompting emergent ICA stenting. The NIHSS worsening was attributed to the overall complex clinical course rather than the carotid stenting procedure itself. Mean procedural time was longer with combined Neuroguard and adjunct filter use (16 minutes) compared with Neuroguard alone (2.5 minutes). No distal embolic events were identified on postprocedural clinical assessment, and no periprocedural ischemic stroke, intracranial hemorrhage, or myocardial infarction occurred.Conclusion In this single-center experience, the Neuroguard IEP™ system demonstrated high technical success and no clinically evident embolic events when used alone or with adjunct distal protection in symptomatic carotid stenosis patients. Use of Neuroguard alone was associated with shorter procedural time, suggesting potential workflow efficiency advantages without compromising clinical safety. These findings support the feasibility of Neuroguard as a standalone embolic protection strategy during CAS. Larger prospective multicenter studies are warranted to validate these observations and further define optimal embolic protection approaches.Disclosures S. Vyas: None. T. Snyder: None. S. Scarpiello: None. J. Haimi: None. Z. Singh: None. B. Percival: None. P. Sharma: None. H. Zacharatos: None. B. Jankowitz: None.