Association between periodontitis and rupture of saccular intracranial aneurysms: a multicenter cross-sectional study.

Abstract

This study aimed to explore the association between periodontitis and rupture of saccular intracranial aneurysms (SIAs). Patients with ruptured and unruptured SIAs were consecutively included in three hospitals, and periodontal examination was conducted to assess the presence of periodontitis. Multivariate generalized linear mixed-effects models was used to assess the association between periodontitis/edentulism and aneurysm rupture. Subgroup analysis evaluated the consistency and variability of above association. The dose-response relationship between periodontitis severity, assessed by clinical attachment loss (CAL) and probing depth (PD), and aneurysm rupture was also analyzed, along with tests for trend. This study involved 622 patients with 716 SIAs. Periodontitis was significantly associated with SIA rupture (OR = 2.65, p<0.001). Subgroup analysis revealed differences in the effect sizes of the association based on the aneurysm maximum diameter, with an interaction p-value of 0.045. In aneurysms ≤ 5 mm in diameter, the association was stronger (OR = 4.04, p < 0.001) compared to those > 5 mm (OR = 1.76, p = 0.039). No significant associations were observed between edentulism and aneurysm rupture (OR = 1.52, p = 0.208), nor between periodontitis or edentulism and aneurysm irregularity. A significant dose-response relationship was observed, whereby the correlation with aneurysm rupture increased stepwise with greater CAL-and with PD only at depths ≥ 5 mm-confirming overall trends for both measures. Periodontitis was significantly associated with saccular intracranial aneurysm rupture, with the association being most evident in aneurysms ≤ 5 mm and progressively strengthening with increasing severity of periodontal parameters. Causality remains to be confirmed in prospective or interventional studies.