Napkin-ring sign plaques are associated with clinical outcome in patients with acute ischemic stroke after endovascular therapy
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By
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Linkao Chen
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Rui Huang
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Taotao Tao
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Chengfei Zhu
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Xiaohua Li
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Xinwei He
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June 11, 2026
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Clinical Scorecard: Association of Napkin-Ring Sign Plaques with Clinical Outcomes in Acute Ischemic Stroke Patients Undergoing Endovascular Therapy
At a Glance
| Category | Detail |
|---|
| Condition | |
| Key Mechanisms | Presence and areas of carotid artery napkin ring sign (NRS) plaques affecting recanalization and outcomes. |
| Target Population | |
| Care Setting | |
Key Highlights
- Higher total NRS plaques observed on symptomatic side compared to contralateral side.
- Patients with poor outcomes had a high percentage of total NRS plaques.
- NRS plaque areas significantly correlated with poor outcomes.
- NRS area remained a significant predictor of poor outcomes after adjusting for covariates.
- Association between NRS plaques and increased symptomatic intracranial hemorrhage (sICH).
Guideline-Based Recommendations
Diagnosis
- Use cervicocerebral computed tomography angiography (CTA) for evaluating NRS plaques.
Management
- Consider the burden of NRS plaques when assessing treatment strategies for AIS.
Monitoring & Follow-up
- Monitor for symptomatic intracranial hemorrhage (sICH) post-EVT.
Risks
- Increased risk of poor outcomes associated with higher NRS plaque areas.
Patient & Prescribing Data
Patients with anterior circulation large-vessel occlusion requiring EVT.
NRS plaque characteristics may influence treatment outcomes and strategies.
Clinical Best Practices
- Utilize CTA for noninvasive assessment of carotid plaque morphology.
- Assess NRS plaque burden in patients with AIS to predict outcomes.
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