[Correlation between periodontitis staging and plaque stability in patients with carotid artery stenosis]

Objective: To investigate the correlation between periodontitis staging and plaque stability in patients with carotid artery stenosis (CAS). Methods: Clinical data of patients with CAS combined with periodontitis who underwent carotid endarterectomy in the Department of Vascular Surgery, Nanjing Drum Tower Hospital, from January 2020 to December 2024 were retrospectively collected. All patients underwent preoperative carotid computed tomography angiography (CTA), cone-beam computed tomography (CBCT) of the jaw, and laboratory tests of biochemical indices. Periodontitis staging was assessed according to CBCT findings. Based on pathological examination of carotid plaque specimens, patients were divided into a stable plaque group (n=233) and a vulnerable plaque group (n=175). Multivariable logistic regression analysis was used to examine the association between periodontitis staging and plaque stability. Furthermore, receiver operating characteristic (ROC) curves were drawn to evaluate the efficacy of periodontitis staging and related indicators in predicting plaque stability. Results: A total of 408 patients were enrolled with the age of (67±8) years, including 286 men and 122 women. The stable plaque group aged (67±9) years consisted of 156 men and 77 women, while the vulnerable plaque group aged (69±9) years included 130 men and 45 women. Multivariate analysis revealed that elevated interleukin-6 (IL-6) levels (OR=1.18,95%CI:1.08-1.30), higher C-reactive protein (CRP) levels (OR=1.10,95%CI: 1.03-1.18) and moderate to severe periodontitis stage (moderate periodontitis: OR=1.58, 95%CI: 1.12-2.23; severe periodontitis: OR=2.26, 95%CI: 1.72-3.45), were risk factors for carotid plaque vulnerability. ROC curve analysis demonstrated that when periodontitis severity was moderate or higher, the area under the curve (AUC) of periodontitis stage for predicting plaque stability was 0.75 (95%CI:0.71-0.79,P<0.001), with a sensitivity of 76% and a specificity of 64%. Conclusions: Periodontitis staging is closely associated with plaque stability in patients with CAS. Patients with moderate to severe periodontitis are more likely to have vulnerable carotid plaques.