Aim To investigate the relationship of serum levels of pregnancy-associated plasma protein-A （PAPP-A） with carotid atherosclerotic plaque in acute cerebral infarction. Methods Carotid artery intima-media thickness （IMT） and the characteristic of atherosclerotic plaque were examined by carotid ultrasonography and the levels of serum PAPP-A were measured by enzyme immunoassay in 79 patients with acute cerebral infarction and 64 normal controls.