A case of a 61-year-old man with previous stroke, treated with stent implantation due to carotid artery stenosis, is presented. During the elective procedure we observed acute thrombosis in the carotid artery due to heparin resistance unknown before. Embolectomy with open filter of the distal neuroprotection system was successfully performed. The second procedure, after a few months with a direct thrombin inhibitor, was fully successful.