Introduction: From the results of NASCET and ECST, surgical treatment for carotid artery near occlusion (NO) has not been as effective as of that for severe stenosis. A meta-analysis published in 2015 supported surgical treatment for NO, but this is still controversial because recent large prospective studies such as CREST or ICSS exclude NO. Method: We conducted a retrospective single center case-controlled study in Japan. Among all NO cases from May 2006 to May 2017, we selected those who had internal carotid artery (ICA) without collapse, with collapse but with detection of vascular lumen from neck to intracranium by angiography and MRI, and without mechanical changes of vessel wall. We excluded patients who had ICA with full collapse and without the possibility for expansion. The carotid artery endarterectomy (CEA) or carotid artery stenting (CAS) was performed according to plaque character, position, and expectancy of expansion. The primary outcome was ipsilateral stroke within 90 days after surgery. Secondary outcomes included restenosis of more than 50%, and perioperative complications (postoperative procedural DWI positive, myocardial infarction, death). Result: In the eligible 60 patients, 56 were male, and the median age was 73±6.3. The number of symptomatic lesions and string signs were 27 and 5, and the CEA and CAS groups consisted of 33 and 27 patients, respectively. There was no significant difference between each group in the patient backgrounds other than the age and follow-up period (71 and 76 [p = 0.0093], 63 and 39 months, respectively [p = 0.0185]). Ipsilateral stroke within 90 days after surgery occurred in 0 and 4 patients (p = 0.0328), and restenosis in 7 (3 needed additional CAS) and 3 patients (p = 0.490). The postoperative DWI positive was 7 and 11 (p = 0.095), and all of them were asymptomatic or transient. There were no cases of perioperative myocardial infarction, and perioperative death occurred in 1 patient. Conclusion: CEA group had the advantage of procedural safety but also the risk of restenosis. In CAS group, we can expect good expansions of ICA, but perioperative complications are relatively high. Our results suggest that there exist specific factors including surgical indication which lead to good outcome by surgical treatment.