PURPOSE: To compare the periprocedural and 5-year outcomes between patients with very severe stenosis (80%-99% stenosis) and those with carotid near occlusion (CNO) with full collapse. MATERIALS AND METHODS: Data from patients with very severe stenosis and CNO with full collapse who underwent carotid artery stenting (CAS) at our center were retrospectively analyzed from January 2018 to December 2021. Unmatched and propensity score-matched (PSM) comparisons of periprocedural complications and 5-year follow-up rates for in-stent restenosis, ipsilateral ischemic stroke, myocardial infarction (MI), and mortality were conducted between the two groups. RESULTS: A total of 555 patients (481 patients in the very severe stenosis group and 74 in the CNO with full collapse group) were included. PSM resulted in 61 subjects from the CNO group being matched with 183 from the control group. The periprocedural complications did not differ significantly between the two groups after PSM. The 5-year follow-up results demonstrated no significant differences in outcomes between the two groups. Kaplan-Meier curves showed that the 5-year rate of freedom from stroke was 89% (CNO group) versus 92% (control group) (p = 0.5). The 5-year rate of freedom from in-stent restenosis was 89% (CNO group) versus 91% (control group) (p = 0.64), while that from death, myocardial infarction, and stroke incidence was 84% (CNO group) versus 87% (control group) (p = 0.43). CONCLUSIONS: Carotid near-occlusion with full collapse showed long-term outcomes comparable to those of very severe carotid stenosis following CAS.