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Background Carotid lipid core plaques (LCPs) have been detected during assessment of carotid artery stenosis using catheter-based near-infrared spectroscopy (NIRS). Treatment with carotid artery stenting (CAS) using dual-layered stents might cause plaque protrusion, and subsequent thromboembolic complications.Objective We aimed to evaluate whether the telescopic carotid stenting (TCS) method suppresses plaque protrusion in patients with high LCPs as assessed by NIRS during CAS.Methods Participants comprised 63 consecutive patients with high LCP, defined as maximal lipid core burden index >400, undergoing CAS using dual-layered stents. For comparison, the study was divided into two distinct periods, with stenting by the standard method in the earlier period, and TCS in the later period. NIRS and intravenous ultrasonography (IVUS) were performed at baseline and after balloon dilatation to analyze the maximal lipid core burden index at the minimal luminal area (MLA) (max-LCBI MLA), and the frequency of plaque protrusion.Results Baseline clinical and lesion characteristics, including symptoms, degree of stenosis, and plaque assessment by NIRS-IVUS, were not significantly different. MLA post-balloon percutaneous transmural angioplasty (PTA) was significantly smaller with the TCS method (9.2±1.5 mm 2) than with the standard method (11.7±3.5 mm2, P=0.002), and MLA change ratio before and after post-balloon PTA was significantly smaller with the TCS (2.2±0.6) than with the standard method (2.8±1.1, P=0.038). Plaque protrusion post-CAS was significantly less with the TCS (0 case, 0%) than with the standard method (4 cases, 20%, P=0.008).Conclusion The TCS method suppresses plaque protrusion in patients with high LCPs undergoing CAS, as assessed by NIRS.