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Introduction Stent placement is an effective treatment option for symptomatic patients with severe petrocavernous (PC) segment stenosis of the internal carotid artery (ICA). However, the periprocedural risk and anatomical considerations remain unclear.Aim of Study This study aimed to evaluate the periprocedural complications and dangerous anatomical locations of symptomatic PC-ICA stenosis, focusing on features specific to each occlusion mechanism.Method The present study evaluated the periprocedural complications in 23 patients treated with balloon angioplasty and stent placement for severely symptomatic (>70%) stenotic lesions of the PC-ICA. Patients with acute ischemic stroke who were consecutively registered in a tertiary hospital between March 1, 2018, and February 28, 2023, with PC-ICA stenosis were enrolled.Abstract A27 Figure 1Results Of the 23 patients, 7 and 16 cases involved the PC segments, respectively. No significant differences in baseline characteristics were observed between the patients with and without complications. The numbers of cases with in-stent thrombosis, vasospasm, plaque prolapse or extrusion, and re-occlusion with ocular ischemia were five, two , one, and one, respectively. Imaging confirmed that new diffusion-weighted imaging lesions after the procedure were more common in the complication group than in the without-complication group. The mRS scores at 90 days was significantly worse in patients who experienced complications.Abstract A27 Figure 2Conclusion Balloon angioplasty and stent placement are acceptable treatment options for symptomatic PC-ICA stenosis. The anatomical characteristics of the PC segment include fixed high-angle curves and tortuous sites, along with surrounding structures. Thus, a careful approach and management are crucial for the endovascular treatment of PC-ICA stenosis.Conflict of Interest No