We report the use of ultrasound-guided carotid sinus nerve block for circulatory management during two-stage carotid artery stenting (CAS) in a patient with symptomatic carotid stenosis complicated with decreased cerebral perfusion reserve. The patient was a 70-year-old man with symptoms of ocular ischemia and markedly decreased perfusion of the left cerebral hemisphere observed in single photon emission computed tomography. Ultrasound-guided carotid sinus nerve block was conducted to prevent CAS perioperative circulatory fluctuations caused by carotid sinus reaction (CSR). We did not observe any hemodynamic instability during CAS. There were no complications associated with the nerve block. Although further research is required, the present findings suggest that ultrasoundguided carotid sinus nerve block may safely and effectively prevent CSR in CAS.