Severe carotid stenosis or occlusion may cause insufficient blood flow and lead to distal artery wall collapse and extensive lumen contraction. Whether this ‘adaptive narrowing' can restitute after carotid recanalization is unclear. We report a patient with global ischemia due to occlusions of bilateral carotid and right vertebral arteries. The occluded left carotid was recanalized successfully with angioplasty and stenting. The adaptively narrowed distal carotid did not restitute immediately but regained its morphology 1 week after the procedure. Carotid adaptive narrow distal occlusion or stenosis may not regain its original morphology immediately but several days after recanalization. This knowledge is instructive for treating occlusive carotid diseases.