Carotid napkin-ring sign plaques are associated with early neurological deterioration in lenticulostriate artery branch atheromatous disease.

BACKGROUND: Early neurological deterioration (END) is a frequent and devastating clinical feature of branch atheromatous disease (BAD). The napkin-ring sign (NRS) on computed tomography angiography (CTA) has emerged as a surrogate imaging marker of vulnerable atherosclerotic plaques. This study aimed to investigate the association between carotid NRS plaque burden and END in patients with lenticulostriate artery (LSA)-territory BAD. METHODS: We retrospectively enrolled 247 consecutive patients with LSA-territory BAD. Patients were categorized into END and non-END groups. Carotid NRS plaque presence and area were assessed using CTA. Intracranial arterial stenosis (ICAS) in non-culprit vessels was also evaluated. Associations between carotid NRS plaques, END, and ICAS were analyzed using multivariable logistic regression and receiver operating characteristic (ROC) curve analyses. RESULTS: END occurred in 25.9% of patients. The prevalence and area of carotid NRS plaques were significantly higher in patients with END than in those without END, both ipsilaterally and contralaterally (all p < 0.05). These associations remained significant after adjustment for age, sex, and baseline NIHSS score. ROC analysis demonstrated moderate predictive performance of NRS plaque area for END (AUC = 0.778 ipsilateral; AUC = 0.692 contralateral). Furthermore, patients with ICAS exhibited a significantly higher prevalence of carotid NRS plaques. CONCLUSION: Increased carotid NRS plaque burden is independently associated with END and ICAS in patients with LSA-territory BAD. Carotid NRS plaques may serve as a potential imaging biomarker for identifying BAD patients at high risk of neurological deterioration.