BACKGROUND: The external carotid artery (ECA) is an important source of collateral circulation to the brain. Stenosis of the ECA in ipsilateral ICA occlusion can produce ischemia. OBJECTIVE: To examine the effectiveness of ECA stenting in treating symptomatic ipsilateral ICA occlusion. METHODS: We retrospectively reviewed patient databases from 5 academic medical centers to identify patients who underwent ECA stenting after 1998. RESULTS: Twelve patients (median age, 66 years; range, 45–79 years) were identified. There was severe ECA stenosis ≥ 70% in 11 patients and ipsilateral ICA occlusion in all patients. Symptoms included transient ischemic attack and stroke. ECA stenting was associated with preservation of neurological status in 11 patients and resolution of symptoms in 5 patients at a median follow-up time of 26 months (range, 1–87 months; mean, 29 months). Symptomatic in-stent restenosis did not occur during the follow-up period. CONCLUSION: ECA stenting in symptomatic ipsilateral ICA disease was a potentially effective strategy to preserve neurological function and to relieve ischemic symptoms.