Increased carotid NRS plaque burden is independently associated with END and ICAS in patients with LSA-territory BAD, suggesting carotid NRS plaques may serve as a potential imaging biomarker for identifying BAD patients at high risk of neurological deterioration.
Early neurological deterioration occurred in 25.9% of patients with lenticulostriate artery-territory branch atheromatous disease.
The prevalence and area of carotid napkin-ring sign plaques were significantly higher in patients with END than in those without END, both ipsilaterally and contralaterally.
ROC analysis demonstrated moderate predictive performance of carotid NRS plaque area for early neurological deterioration.
Patients with intracranial arterial stenosis in non-culprit vessels exhibited a significantly higher prevalence of carotid NRS plaques.
The association between carotid NRS plaque burden and END remained significant after multivariable adjustment.
This research suggests that a specific type of vulnerable plaque in the carotid arteries of the neck — identifiable on CT scans by a 'napkin-ring' appearance — is linked to a higher risk of worsening neurological symptoms early after a particular type of small stroke. The study looked at 247 stroke patients whose strokes were caused by disease in small arteries called lenticulostriate arteries, and found that about 1 in 4 of these patients experienced early neurological deterioration (END), meaning their symptoms got noticeably worse shortly after the stroke. Patients who had these napkin-ring sign plaques, whether on the same side or opposite side of the brain as the stroke, were significantly more likely to experience this deterioration. The napkin-ring sign plaques also correlated with the presence of narrowing in brain arteries elsewhere that were not directly responsible for the stroke, suggesting that patients with these plaques tend to have more widespread and unstable atherosclerotic disease throughout their vascular system. When the researchers used these plaque measurements to predict who would deteriorate, the CT-based plaque area showed moderate predictive accuracy, with the area under the curve reaching 0.778 for plaques on the same side as the stroke. This research suggests that routine CT angiography scans — which are already commonly performed when patients have strokes — could potentially be used to identify stroke patients at higher risk of getting worse in the early days after their stroke. Identifying these high-risk patients earlier could be important for clinical monitoring and future research into targeted treatments, though further prospective studies would be needed to confirm these findings and determine how this information should guide patient care.
Huang R, Qu M, Lin Q, Chen Q, Chen L, Tao T, et al.. (2026). Carotid napkin-ring sign plaques are associated with early neurological deterioration in lenticulostriate artery branch atheromatous disease.. Frontiers in neurology. https://doi.org/10.3389/fneur.2026.1822751