Aim To investigate the relationship between Rho/ROCK signal pathway and hemorheology in patients with cerebral arteriosclerosis (CAS). Methods Blood samples were collected from 80 CAS patients and 80 healthy persons. The biochemical parameters, the levels of Ras homolog gene family member A (RhoA) and Rho-associated kinase 2 (ROCK2), blood cell-specific volume, whole blood apparent viscosity (high shear and low shear) and plasma viscosity were measured. Hemorheological indexes, RhoA and ROCK2 levels were compared between the two groups.The correlations between RhoA, ROCK2 levels and hemorheological parameters were analyzed in CAS patients. ResultsThe smoking rate, body mass index, fasting plasma glucose, 2-hour postprandial plasma glucose, high density lipoprotein cholesterol, low density lipoprotein cholesterol, triglyceride and serum homocysteine in CAS group were higher than those in control group (P＜0.05). The blood cell-specific volume, whole blood apparent viscosity (high shear and low shear), plasma viscosity, ROCK2 and RhoA levels in CAS group were higher than those in control group (P＜0.05). Pearson correlation analysis and multiple linear regression analysis showed that serum ROCK2 level was positively correlated with blood cell-specific volume, whole blood apparent viscosity (high shear and low shear) and plasma viscosity; RhoA level was positively correlated with whole blood apparent viscosity (high shear and low shear). Conclusion Rho/ROCK signal pathway is closely related to abnormal hemorheology in CAS patients, and it may be involved in the occurrence and development of CAS.