Background Carotid artery lesions with high signal on MR black-blood (BB) images look at high risk for symptomatic embolic complications following carotid artery stenting (CAS).

Purpose The aim of our study was to investigate the effectiveness of our strategy to prevent symptomatic complications following CAS of MR-BB high-signal lesions.

Methods We included in our study patients who underwent elective CAS of MR-BB high-signal lesions between Jan 2015 and Aug 2016.Symptomatic patients underwent CAS 30 days or later after their ischemic events. We performed transbrachial CAS as following; introducing the Spider filter device distal to BB-high lesionsthrough the MSK-guide (6Fr Simmonds-type super-long sheath), dilatation of lesions with a 3mm-diameter balloon catheter (Shiden) and deployment of CarotidWallstents without post-CAS balloon dilatation. Patients started to take clopidogrel and cilostazol before CAS and continued to do them after CAS. They took Yokukansan (TJ-54, Japanese Kampo) and etizolam or suvorexant during peri-CAS periods. We evaluated symptomatic complications.

Results Twenty-nine patients were analyzed.Their average age was 77 years. They had MR-BB high lesions and their average NASCET stenosis rate of 70%, which were reduced to 34.5% after CAS. Neither symptomatic ischemic complications nor hyperperfusion syndrome occurred during peri-CAS average hospitalization of 4.8 days.

Conclusion Our strategy of elective CAS for MR-BB high-signal lesions was effective in preventing symptomatic complications.

Disclosures: T. Mori: 6; C; Royalty, Meditit. Y. Tanno: None. S. Kasakura: None. K. Yosioka: None. N. Nakai: None.