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Updated: Jun 23, 2026

Isolation and Cannulation of Cerebral Parenchymal Arterioles
Published on: May 23, 2016
Napkin-ring sign plaques are associated with cerebral small vessel disease
Hui Zhou1, Qiao Lin2, Xinwei He2
1Department of Radiology, Taizhou Central Hospital (Taizhou University Hospital), School of Medicine, Taizhou University, Taizhou, 318000, Zhejiang, China.
Background:
Few studies have investigated the association between the carotid artery napkin-ring sign (NRS) and cerebral small vessel disease (CSVD). This study aimed to investigate whether carotid NRS plaque burden and CSVD are associated.
Methods:
This retrospective, single-center, cross-sectional study following STROBE guidelines enrolled patients with symptoms or clinical suspicion of anterior circulation acute ischemic stroke (AIS). Plaques were evaluated using preoperative cervicocerebral computed tomography angiography (CTA). Imaging markers of CSVD, such as white matter hyperintensities (WMHs) and perivascular spaces (PVSs), were assessed.
Results:
A total of 575 patients (64.9 ± 8.0 years, 378 men) were evaluated. Patients with AIS had a higher percentage of total NRS plaques than those in the control group (144 (37.1%) vs. 45 (24.1%), P = 0.002), and the total NRS amount increased the risk of AIS after adjusting for confounding factors (odds ratio 1.717; 95%CI 1.141-2.584; P = 0.009). A higher WMHs grade was associated with the presence of NRS plaques (P < 0.001) and a higher total NRS area (P < 0.001). A higher PVSs grade was associated with positive remodeling (PR) on the NRS (P = 0.006).
Conclusions:
An increased incidence of NRS plaques on CTA was associated with the occurrence of AIS, and the area and PR of NRS plaques were associated with the risk stratification of CSVD.
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