Carotid artery calcification in stroke patients - a pilot study

Carotid artery calcifications can be diagnosed in panoramic radiographs as radio-opaque masses adjacent to the cervical spine in the level of third and fourth cervical vertebrae and the hyoid bone. An association of carotid calcifications with carotid atheromatosis which in turn increases the risk of ischemic stroke is assumed. Objectives: The aim of the study was to examine the incidence of carotid calcifications in standard dental panoramic radiographs and their association to gender, previous medical history as well as oral status in order to assess the predictive value of panoramic radiography in the early diagnosis of carotid artery calcifications. Subjects: Fourteen patients admitted to Geneva University Hospital with a recent ischemic cerebrovascular accident (7 men, 7 women average age of 70 years 8 months). All patients presented with a stenosis of the carotid as confirmed by Duplex sonography at admission. Method: Panoramic X-rays of the patients were digitised and examined independently by two clinicians. Results: Nine carotid artery calcifications were detected on panoramic radiographs in 8 of the subjects. Most of the carotid artery calcifications were detected in the right side (n=6). No correlation was found between the side of the calcification and the cerebral lesion. Five patients had multiple vascular risk factors, elevated blood pressure being the most aggravating (p<0.01). The prevalence of carotid artery calcifications was higher in female than male patients (6 vs 3). Seven of the eight patients with carotid calcifications presented clinical and radiological signs of periodontal disease, which might suggest a relation between the presence of periodontopathic bacteria and a specific response associated with atherosclerosis. Conclusions: Panoramic radiographs might be a useful tool for the diagnosis of risk factors of vascular stroke. Therefore, dentists who identify carotid artery calcifications on panoramic radiographs should refer the patients for appropriate prophylactic procedures. Funding by FNS