Relationship between symptomatic lower limb peripheral artery disease and calcified carotid artery plaque detected on panoramic images of neurologically asymptomatic males

Abstract

Objective: Males with peripheral arterial disease (PAD) are at high risk of ischaemic stroke given that atherogenic risk factors for both diseases are similar. We hypothesized that neurologically asymptomatic males diagnosed with PAD would demonstrate calcified carotid artery plaques (CCAP) on panoramic images (PI) significantly more often than similarly aged males not having PAD.

Methods: Investigators implemented a retrospective cross-sectional study. Subjects were male patients over age 50 diagnosed with PAD by ankle-brachial systolic pressure index results of ≤ 0.9. Controls negative for PAD had an ankle-brachial systolic pressure index > 0.9. Predictor variable was a diagnosis of PAD and outcome variable was presence of CCAP. Prevalence of CCAP amongst the PAD+ patients was compared to prevalence of CCAP among PAD- patients. Descriptive and bivariate statistics were computed and p-value was set at 0.05.

Results: Final sample size consisted of 234 males (mean age 72.68 ± 9.09); 116 subjects and 118 controls. Among the PAD+ cohort, CCAP+ prevalence rate (57.76%) was significantly (p = 0.001) greater than the CCAP+ rate (36.44%) of the PAD- (control). There was no significant difference in atherogenic "risk factors" in the PAD+ cohort between CCAP+ and CCAP- subjects.

Conclusion: We demonstrated that CCAP, a "risk factor" for future stroke and "risk indicator" of future myocardial infarction is seen significantly more often detected on the PIs of older male patients with PAD than among those without. Dentists treating patients with PAD must be uniquely vigilant for the presence of CCAPs on their patients' PI.

Keywords: carotid arteries; male; panoramic radiography; peripheral arterial disease; veterans.

Figures

Figure 1.

CTA of an 87-year-old male with bilateral intermittent claudication after half block of walking confirmed as PAD with a resting brachial-ankle index study of 0.4 in the left leg and an inaudible doppler reading in the right leg. Arrow (A) denotes multiple “tandem” SFA stenoses in the right leg; arrow (B) identifies a site of occlusion in the SFA in the left leg; and, arrow (C) indicates severe atherosclerotic disease in the tibial artery leading to complete occlusion of all three tibial vessels by mid-calf of the right leg. CTA, CT angiogram; PAD, peripheral arterial disease; SFA, superficialfemoral artery.

Figure 2.

The panoramic image of the same 87-year-old male with peripheral arterial disease. The image, which has been digitally enhanced with the manufacturer’s provided software, shows bilateral calcified carotid artery plaque (arrows) anterior to the fourth cervical vertebrae.