Objective:

To investigate the association between the burden of carotid artery napkin ring sign (NRS) plaques and outcomes in patients with acute ischemic stroke (AIS) requiring endovascular therapy (EVT).

Approach:

Key Findings:

• Higher total NRS plaques and areas were observed on the symptomatic side compared to the contralateral side.
• Patients with poor outcomes had a higher percentage of total NRS plaques on both sides.
• NRS plaque areas were significantly higher in patients with poor outcomes and showed good diagnostic accuracy for predicting poor outcomes.
• The association between NRS area and poor outcome remained statistically significant after adjusting for covariates.

Interpretation:

The presence and areas of NRS plaques on cervicocerebral CTA are associated with reduced recanalization and poor outcomes in AIS patients after EVT.

Limitations:

• Single-center study may limit generalizability.
• Retrospective design may introduce selection bias.

Conclusion:

NRS plaques are associated with adverse clinical outcomes in AIS patients undergoing EVT.

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