In chronic kidney disease, contrast agent clearance half-life is significantly prolonged with decreasing estimated glomerular filtration rate ¹ . Carotid artery calcification is common in the elderly ² , with segmental distribution including the C1 segment in 53% of cases ³ . Severe circumferential or near-circumferential calcification is visible under fluoroscopy and may pose challenges to interventional procedures ⁴ . We present a case of carotid artery stenting in the C1 segment performed without contrast agent, using calcified plaque for guidance in a patient with chronic kidney disease (video). This technique, analogous to standard stenting, is tailored for patients with calcified plaque and renal impairment. In this procedure, calcific plaques served as reliable fluoroscopic landmarks for microwire navigation, balloon positioning, and stent deployment. Post-procedure DWI revealed multiple small hyperintense lesions, indicating embolic risk despite the patient remaining asymptomatic.