Frontiers in neurology · 2026
Napkin-ring sign plaques are associated with clinical outcome in patients with acute ischemic stroke after endovascular therapy.
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Chen Linkao, Huang Rui, Tao Taotao, Zhu Chengfei, Li Xiaohua, He Xinwei
Аннотация
OBJECTIVES: Few studies have investigated the association between the carotid artery napkin ring sign (NRS) and acute ischemic stroke (AIS). This study investigated whether the burden of carotid artery NRS plaques affects the outcomes of patients with AIS requiring endovascular therapy (EVT).
METHODS: This retrospective, single-center study enrolled patients with large-vessel occlusion of the anterior circulation. Plaques were evaluated using preoperative cervicocerebral computed tomography angiography. Successful arterial recanalization was defined as a modified thrombolysis score of 2b to 3 for cerebral infarction on the final angiographic examination. A poor outcome was defined as a modified Rankin scale (mRS) score >2 at 3 months after stroke. We used univariate and logistic regression analyses to assess NRS plaque characteristics and the association between NRS plaques and revascularization and functional outcomes in patients with AIS requiring endovascular therapy.
RESULTS: Higher total NRS plaques and areas were observed on the symptomatic side than on the contralateral side. Patients with poor outcomes had a high percentage of total NRS plaques on both symptomatic and contralateral sides in the univariate analyses. NRS plaque areas were significantly high in patients with poor outcomes and showed good diagnostic accuracy in discriminating the presence of a poor outcome on both sides. After adjusting for other covariates, the association between the NRS area and poor outcome remained statistically significant.
CONCLUSION: We documented that the presence and areas of NRS plaques on cervicocerebral CTA are associated with reduced recanalization, increased symptomatic intracranial hemorrhage (sICH), and poor outcomes in patients with AIS after EVT.
METHODS: This retrospective, single-center study enrolled patients with large-vessel occlusion of the anterior circulation. Plaques were evaluated using preoperative cervicocerebral computed tomography angiography. Successful arterial recanalization was defined as a modified thrombolysis score of 2b to 3 for cerebral infarction on the final angiographic examination. A poor outcome was defined as a modified Rankin scale (mRS) score >2 at 3 months after stroke. We used univariate and logistic regression analyses to assess NRS plaque characteristics and the association between NRS plaques and revascularization and functional outcomes in patients with AIS requiring endovascular therapy.
RESULTS: Higher total NRS plaques and areas were observed on the symptomatic side than on the contralateral side. Patients with poor outcomes had a high percentage of total NRS plaques on both symptomatic and contralateral sides in the univariate analyses. NRS plaque areas were significantly high in patients with poor outcomes and showed good diagnostic accuracy in discriminating the presence of a poor outcome on both sides. After adjusting for other covariates, the association between the NRS area and poor outcome remained statistically significant.
CONCLUSION: We documented that the presence and areas of NRS plaques on cervicocerebral CTA are associated with reduced recanalization, increased symptomatic intracranial hemorrhage (sICH), and poor outcomes in patients with AIS after EVT.