Abstract
Methods Thrombus aspirates and control arterial blood were taken from 71 patients (70.4% male; mean age, 67.4 years) with acute ischemic stroke. Tooth pathology was registered using CT scans. Carotid stenosis was estimated with CTA and ultrasonography. The presence of bacterial DNA from aspirated thrombi was determined using quantitative PCR. We also analyzed the presence of these bacterial DNAs in carotid endarterectomies from patients with peripheral arterial disease. Results Bacterial DNA was found in 59 (83.1%) of the thrombus aspirates (median, 8.6-fold). Oral streptococcal DNA was found in 56 (78.9%) of the thrombus aspirates (median, 5.1-fold). DNA from A. actinomycetemcomitans and P. gingivalis was not found. Most patients suffered from poor oral health and had in median 19.0 teeth left. Paradoxically, patients with better oral health had more oral streptococcal DNA in their thrombus than the group with the worst pathology (p = 0.028). There was a trend (OR 7.122; p = 0.083) in the association of ≥50% carotid artery stenosis with more severe dental pathology. Oral streptococcal DNA was detected in 2/6 of carotid endarterectomies. Conclusions Stroke patients had poor oral health which tended to associate with their carotid artery stenosis. Although oral streptococcal DNA was found in thrombus aspirates and carotid endarterectomy samples, the amount of oral streptococcal DNA in thrombus aspirates was the lowest among those with the most severe oral pathology. These results suggest that the association between poor oral health and acute ischemic stroke is linked to carotid artery atherosclerosis.
Highlights
Cardiovascular and cerebrovascular diseases are one of the leading causes of death and disability worldwide, with acute ischemic stroke alone resulting in over 5 million deaths annually [1, 2]
One arterial blood sample was positive for P. gingivalis, and two arterial blood samples were positive for A. actinomycetemcomitans bacterial DNA
We found an inverse association of the severity of oral pathology but a positive trend of carotid artery stenosis with the amount of streptococcal DNA in thrombus aspirates of stroke patients
Summary
Cardiovascular and cerebrovascular diseases are one of the leading causes of death and disability worldwide, with acute ischemic stroke alone resulting in over 5 million deaths annually [1, 2]. Risk of acute ischemic stroke has been associated with carotid artery atherosclerosis as well as with periodontal disease. We studied whether oral pathology or carotid atherosclerosis was associated with the presence and quantity of bacterial DNA in their aspirated thrombi. We analyzed the presence of these bacterial DNAs in carotid endarterectomies from patients with peripheral arterial disease. Stroke patients had poor oral health which tended to associate with their carotid artery stenosis. Oral streptococcal DNA was found in thrombus aspirates and carotid endarterectomy samples, the amount of oral streptococcal DNA in thrombus aspirates was the lowest among those with the most severe oral pathology These results suggest that the association between poor oral health and acute ischemic stroke is linked to carotid artery atherosclerosis
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