The role of inflammation in carotid plaque formation and instability has been highlighted in recent studies. We assessed the significance of smoking status on systemic inflammation and their relationships with carotid stenosis and carotid plaque surface characteristics. A total of 822 patients diagnosed with carotid artery stenosis were recruited and evaluated with systemic inflammation indices according to smoking status. Subgroups were balanced in terms of gender, age, and additional diseases. Systemic inflammation indices were found to be substantially higher in smokers (P < .001) and in patients with irregular-ulcerated surface plaques (P < .001). Plaque surfaces were more irregular and ulcerated in smokers (P < .001). No difference was detected between stenosis degree and smoking status or with systemic inflammation (P > .05). Pan-immune-inflammatory value (PIV) had a strong correlation with both smoking and plaque instability (P < .001, r = .771). Additionally, high PIV levels displayed a significant risk augmentation for irregular/ulcerated surface plaques (P < .001, Odds Ratio (OR):13.796; 95%CI, 5.647-33.701). These findings suggest that in patients with carotid atherosclerotic stenosis, systemic inflammatory markers especially PIV, alongside with plaque surface characteristics, may serve as valuable tools for evaluating and monitoring plaque inflammation. This may lead to more personalized and effective treatment strategies, particularly in smokers.
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