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Chen BJ, Zeng ZX, Zhao YX, Wu MW, Bao X, Li T, Feng J, Li ZJ, Zhang GL, Feng R. Angioplasty for Supra-Aortic Arterial Lesions from Takayasu Arteritis: Efficacy of Cutting Balloon Angioplasty Versus Conventional Balloon Angioplasty. Ann Vasc Surg 2023:S0890-5096(23)00100-0. [PMID: 36805427 DOI: 10.1016/j.avsg.2023.01.050] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2021] [Revised: 01/17/2023] [Accepted: 01/27/2023] [Indexed: 02/18/2023]
Abstract
BACKGROUND This retrospective study aimed to evaluate the safety and efficacy of cutting balloon angioplasty and conventional balloon angioplasty in supra-aortic arterial lesions caused by Takayasu arteritis. METHODS A total of 46 patients with supra-aortic arterial lesions between January 2011 and December 2018 were included. Cutting balloon angioplasty was applied for 17 patients with 24 supra-aortic arterial lesions (group A), while 29 patients with 36 supra-aortic arterial lesions received conventional balloon angioplasty (group B). The preoperative clinical manifestation, operation result, and postoperative outcomes were recorded and compared in the 2 groups. RESULTS Dizziness, visual disturbance, and unequal/absent pulses were the most common manifestations. The technical success of revascularization was 93.5% (43/46) in patients and 93.3% (56/60) in lesions. The stent implantation rate in group A was significantly lower than that in group B (4.2% vs. 50% in lesions, P < 0.05). Restenosis was the most common complication in both groups. Although the early (≤30 days) and late (>30 days) complications in group A were less than those in group B, there was no significant difference between the 2 groups (P > 0.05). Moreover, the primary-assisted patency of cutting balloon angioplasty and conventional balloon angioplasty at 1, 2, and 5 years were 66.7%, 62.5%, and 62.5% and 61.1%, 58.2%, and 49.8%, there was no significant difference between the 2 groups (P > 0.05), respectively. CONCLUSIONS Compared with conventional balloon angioplasty, cutting balloon angioplasty could be considered a safe and effective alternative for supra-aortic arterial lesions caused by Takayasu arteritis, demonstrating better patency and clinical benefit.
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Affiliation(s)
- Bing-Ji Chen
- Department of Emergency Surgery, Second Affiliated Hospital of Fujian Medical University, Quanzhou, Fujian, China
| | - Zhao-Xiang Zeng
- Department of Vascular Surgery, Changhai Hospital, Navy Medical University, Shanghai, China
| | - Yu-Xi Zhao
- Department of Vascular Surgery, Changhai Hospital, Navy Medical University, Shanghai, China
| | - Ming-Wei Wu
- Department of Vascular Surgery, Changhai Hospital, Navy Medical University, Shanghai, China
| | - Xianhao Bao
- Department of Vascular Surgery, Changhai Hospital, Navy Medical University, Shanghai, China
| | - Tao Li
- Department of Vascular Surgery, Changhai Hospital, Navy Medical University, Shanghai, China
| | - Jiaxuan Feng
- Department of Vascular Surgery, Changhai Hospital, Navy Medical University, Shanghai, China
| | - Zhen-Jiang Li
- Department of Vascular Surgery, The First Affiliated Hospital of the Medical School of Zhejiang University, Hangzhou, Zhejiang, China.
| | - Guang-Lin Zhang
- Department of General Surgery, Jiuquan City People's Hospital, Jiuquan, Gansu, China.
| | - Rui Feng
- Department of Vascular Surgery, Shanghai General Hospital, Shanghai, China.
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Carotid-Vertebral or Carotid-Subclavian Transpositions in Supra-Aortic Steno-Occlusive Diseases When Endovascular Therapy Is Unfeasible or Unsuccessful. Int Surg 2021. [DOI: 10.9738/intsurg-d-17-00097.1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Background and purpose
Despite advances in endovascular therapies, some patients experience vertebral artery stenosis or subclavian artery occlusion and may not benefit from less-invasive angioplasty/stenting. This study described 4 cases in which carotid-vertebral transposition (CVT) or carotid-subclavian transposition (CST) was adapted when endovascular treatment was unfeasible or unsuccessful.
Presentation
Case 1: A 65-year-old woman presented with severe stenosis of the right vertebral artery ostium, dysplastic left vertebral artery, and aneurysmal dilatation of proximal right subclavian artery and brachiocephalic trunk. Case 2: A 23-year-woman had severe stenosis at the first portion of left vertebral artery caused by Takayasu's arteritis. Because endovascular intervention was unfeasible, CVTs were performed in cases 1 and 2. Case 3: A 73-year-old man presented with total occlusion of the proximal right subclavian artery and severe stenosis of the right internal carotid artery. Case 4: A 58-year-old man experienced complete occlusion of the left subclavian artery and severe stenosis of the left common carotid artery. Duplex ultrasonography showed reverse flow in the vertebral artery in keeping with vertebral steal syndrome. Endovascular treatment was unsuccessful because the wire did not cross the occlusion of the subclavian artery. CSTs were performed with concurrent ipsilateral carotid endarterectomy in cases 3 and 4.
Conclusion
The present case series demonstrated that CST and CVT were effective treatment modalities for subclavian or vertebral artery lesions. Although endovascular stenting and angioplasty have been advocated as first-line management, CST and CVT should be considered as the remedy when endovascular intervention is unsuccessful or unfeasible.
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Tatsuno K, Ueda T, Usuki N, Otsubo H, Araga T, Yoshie T, Takaishi S, Yoshida Y, Ono H. A Case of Acute Ischemic Stroke Treated with Endovascular Treatment for Tandem Occlusion of the Common Carotid Artery and Internal Carotid Artery Terminal Portion Related to Takayasu Arteritis. JOURNAL OF NEUROENDOVASCULAR THERAPY 2020; 15:387-395. [PMID: 37502416 PMCID: PMC10370951 DOI: 10.5797/jnet.cr.2020-0074] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/08/2020] [Accepted: 10/07/2020] [Indexed: 07/29/2023]
Abstract
Objective This report presents a case of mechanical thrombectomy for left internal carotid artery (ICA) terminal portion occlusion performed by left common carotid artery recanalization during hospitalization after diagnosing bilateral common carotid artery occlusion due to Takayasu arteritis. Case Presentation A 25-year-old woman with fever and cervix pain a few months ago visited our department after repeated transient aphasic attacks. Magnetic resonance imaging (MRI) demonstrated diffuse infarction in the left middle cerebral artery (MCA) area, and she was diagnosed with Takayasu arteritis due to bilateral common carotid artery occlusion and left subclavian artery stenosis. On the 20th day of hospitalization, the terminal portion of the left ICA was occluded and thrombectomy was performed after balloon dilation of the left common carotid artery. Lastly, left common carotid artery stenting was performed. Aphasia and sensory disturbance remained, but she was transferred to a rehabilitation hospital with a modified Rankin Scale (mRS) of 2 on the 65th day of hospitalization. Antithrombotic and immunosuppressive therapy were performed, and restenosis did not develop. Conclusion Angioplasty and stenting of common carotid artery occlusion can be effective treatments in thrombectomy for intracranial occlusion due to Takayasu disease.
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Affiliation(s)
- Kentaro Tatsuno
- Department of Neurology, Stroke Center, St. Marianna University Toyoko Hospital, Kawasaki, Kanagawa, Japan
| | - Toshihiro Ueda
- Department of Neurology, Stroke Center, St. Marianna University Toyoko Hospital, Kawasaki, Kanagawa, Japan
| | - Noriko Usuki
- Department of Neurology, Stroke Center, St. Marianna University Toyoko Hospital, Kawasaki, Kanagawa, Japan
| | - Haruki Otsubo
- Department of Neurology, Stroke Center, St. Marianna University Toyoko Hospital, Kawasaki, Kanagawa, Japan
| | - Takashi Araga
- Department of Neurology, Stroke Center, St. Marianna University Toyoko Hospital, Kawasaki, Kanagawa, Japan
| | - Tomohide Yoshie
- Department of Neurology, Stroke Center, St. Marianna University Toyoko Hospital, Kawasaki, Kanagawa, Japan
| | - Satoshi Takaishi
- Department of Neurology, Stroke Center, St. Marianna University Toyoko Hospital, Kawasaki, Kanagawa, Japan
| | - Yasuyuki Yoshida
- Department of Neurosurgery, Stroke Center, St. Marianna University Toyoko Hospital, Kawasaki, Kanagawa, Japan
| | - Hajime Ono
- Department of Neurosurgery, Stroke Center, St. Marianna University Toyoko Hospital, Kawasaki, Kanagawa, Japan
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Petrov IS, Tasheva IG, Tsonev SN, Stankov Z, Pavlova SA, Grozdisnki LN. Late outcomes after interventional treatment - Successful stenting of Takayasu arteritis lesions. Single center experience in Bulgaria. COR ET VASA 2018. [DOI: 10.1016/j.crvasa.2017.06.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Keser G, Aksu K. What is new in management of Takayasu arteritis? Presse Med 2017; 46:e229-e235. [PMID: 28774475 DOI: 10.1016/j.lpm.2016.11.033] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/12/2016] [Accepted: 11/14/2016] [Indexed: 10/19/2022] Open
Abstract
Management of Takayasu arteritis (TAK) is challenging mostly due to difficulties in assessing actual disease activity. The rational of medical treatment is to suppress both vascular and systemic inflammation with appropriate systemic immunosuppression, including corticosteroids and conventional immunosuppressive (IS) agents. In case of refractory disease activity, biologic agents such as TNF inhibitors and tocilizumab may be tried. In selected cases, endovascular interventions and surgical procedures may be indicated and should be performed during inactive disease. Among conventional IS agents, new data is available for leflunomide. On the other hand, most of the new information in the management of TAK arises from the growing experience with biologic agents used in resistant cases. Besides, there are potential new therapeutic targets which may be promising in the future for medical treatment of TAK. Finally, new trends in endovascular interventions for management of TAK deserve attention.
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Affiliation(s)
- Gokhan Keser
- Ege University School of Medicine, Department of Internal Medicine, Division of Rheumatology, Bornova, Izmir, Turkey.
| | - Kenan Aksu
- Ege University School of Medicine, Department of Internal Medicine, Division of Rheumatology, Bornova, Izmir, Turkey
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Luo XY, Wu QH, Zhang FX. Open and Endovascular Management of Severe Cerebral Ischemia in Takayasu's Arteritis. Ann Vasc Surg 2017; 42:101-110. [PMID: 28258019 DOI: 10.1016/j.avsg.2017.01.001] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2016] [Accepted: 01/18/2017] [Indexed: 12/01/2022]
Abstract
BACKGROUND Severe cerebral ischemia in patients with Takayasu's arteries was caused by occlusion of most supra-aortic arteries. Arterial revascularization is necessary to decrease the incidence of stroke and improve the quality of life but may be complicated with multiple occlusive lesions and inflammation condition of this disease. This study was to assess options and long-term outcomes of surgical and endovascular treatment. METHODS Twenty-nine patients with severe cerebral ischemic symptoms underwent surgical or endovascular treatment from January 1991 to July 2015. Demographic characteristics, surgical and endovascular procedures, and follow-up outcomes were reviewed. Risk factors associated with primary patency of surgical treatment and assisted primary patency of endovascular treatment was identified by Cox regression analyses. RESULTS There were 29 patients with a median age of 24 (range 9-37 years), 9 in active and 20 in inactive phase. Seventeen patients underwent a variety of bypass procedures. Fourteen endovascular procedures were performed in 12 patients. No death occurred within 30 days after both procedures. Complications within 30 days after bypass included stroke in 1 patient, infection in 2 patients, and heart failure in 1 patient. Nine patients developed brain hyperperfusion after bypass. Transient hemiplegic paralysis occurred in 1 patient during dilation of the carotid artery. During a median follow-up time of 41 months, primary and secondary patency rate of bypass at 1 and 3 years was 93.75% and 100% and 87.5% and 100%, respectively. Assisted primary and secondary patency rate of endovascular treatment at 1 and 3 years was 85.71% and 92.86% and 68.18% and 75.66%, respectively. There was no independent risk factor associated with either primary patency of surgical treatment or assisted primary patency of endovascular treatment. Disease activity was independent risk factor associated with combined rate of primary patency of surgical treatment and assisted primary patency of endovascular treatment (HR: 0.17, 95% CI: 0.03-0.93, P = 0.04). CONCLUSIONS Bypass is the preferred treatment in majority of patients with good long-term patency, even has a higher propensity for postoperative complications. Endovascular treatment should be preserved for short lesions in inappropriate or high-risk surgical patients but needs more reintervention and close monitoring of lesion for better outcomes. Long-term patency of surgical and endovascular treatment is related with disease activity. Combination of surgical or endovascular treatment and medical therapy may improve the efficacy of interventions.
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Affiliation(s)
- Xiao Yun Luo
- Department of Vascular Surgery, Beijing Shijitan Hospital, Capital Medical University, Beijing, China
| | - Qing Hua Wu
- Department of Vascular Surgery, Beijing Anzhen Hospital, Capital Medical University, Beijing, China.
| | - Fu Xian Zhang
- Department of Vascular Surgery, Beijing Shijitan Hospital, Capital Medical University, Beijing, China
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New endovascular techniques for treatment of life-threatening Takayasu arteritis. ADVANCES IN INTERVENTIONAL CARDIOLOGY 2016; 12:171-4. [PMID: 27279878 PMCID: PMC4882391 DOI: 10.5114/aic.2016.59369] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2015] [Accepted: 12/21/2015] [Indexed: 11/17/2022] Open
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Updates in Pathophysiology, Diagnosis and Management of Takayasu Arteritis. Ann Vasc Surg 2016; 35:210-25. [PMID: 27238990 DOI: 10.1016/j.avsg.2016.02.011] [Citation(s) in RCA: 73] [Impact Index Per Article: 9.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2016] [Revised: 02/18/2016] [Accepted: 02/19/2016] [Indexed: 02/06/2023]
Abstract
BACKGROUND Takayasu arteritis (TA) is a rare, systemic, inflammatory vasculitis of granulomatous nature, and still of unknown etiology. It mainly involves the aorta and its major branches and is more commonly seen in women of childbearing age and Asians. TA leads to stenosis, occlusion, or aneurysmal degeneration of large arteries, and its pathogenesis seems to be mainly due to an abnormal cell-mediated immunity, although other molecular and genetic abnormalities may contribute. The diagnosis and treatments lie on clinical and arteriographic findings. Because of its fluctuating course, both clinical scores and biomarkers are currently evaluated. The aim of this review is to report a comprehensive and methodologically robust state of the art about Takayasu arteritis, including the latest data and evidences in the definition, epidemiology, pathogenesis and etiology, clinical manifestations and classification, diagnosis, assessment of disease activity and progression, biomarkers, and treatment. METHODS We searched all publications addressing definition, epidemiology, pathogenesis, etiology, classification, diagnosis, biomarkers, and treatment of TA. Randomized trials, cohort studies, and reviews were contemplated to give a breadth of clinical data. PubMed and Scopus were searched from August 2010 to November 2015. RESULTS Of the 3,056 records found, 267 matched our inclusion criteria. After reading the full-text articles, we decided to exclude 169 articles because of the following reasons: (1) no innovative or important content; (2) no multivariable analysis; (3) insufficient data; (4) no clear potential biases or strategies to solve them; (5) no clear end-points; and (6) inconsistent or arbitrary conclusions. The final set included 98 articles. CONCLUSIONS This review presents the last updates in all fields of Takayasu arteritis. Still today, large areas of TA pathogenesis and disease-activity assessment need to be further investigated to better treat patients with TA.
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Fritz Angle J, Nida BA, Matsumoto AH. Endovascular Treatment of Large Vessel Arteritis. Tech Vasc Interv Radiol 2014; 17:252-7. [DOI: 10.1053/j.tvir.2014.11.006] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
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Reocclusion and stroke due to immediate plaque protrusion following endovascular treatment of carotid artery successfully treated with intra-arterial urokinase and stent in stent in a patient with Takayasu arteritis with severe disease of all arch vessels. Cardiovasc Interv Ther 2013; 28:394-7. [PMID: 23568587 DOI: 10.1007/s12928-013-0176-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2013] [Accepted: 03/27/2013] [Indexed: 10/27/2022]
Abstract
Endovascular treatment is becoming a safe and efficacious modality in the management of carotid artery stenosis in Takayasu arteritis (TA). A 24-year-old woman of TA presented with blurred vision, recurrent syncope and upper limb claudication. Angiography revealed right CCA 95 %, left CCA 90 % stenosis and occlusion of other arch vessels. She underwent right CCA angioplasty and stenting. She developed left-sided hemi paresis. Check angiogram revealed plaque protrusion in the proximal part of the stented segment. Intra-arterial urokinase bolus was given and overlapping stenting done. Re-occlusion by plaque protrusion immediately after stenting like in our case is not reported.
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Rogers RK, Sakhuja R, Margey R, Stone JH, Rosenfield K, Jaff MR. Transient ischemic attacks in a 22-year-old. Am J Med 2012; 125:148-54. [PMID: 22269617 DOI: 10.1016/j.amjmed.2011.08.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/19/2011] [Revised: 08/01/2011] [Accepted: 08/01/2011] [Indexed: 11/17/2022]
Affiliation(s)
- R Kevin Rogers
- Division of Cardiology, Department of Medicine, Section of Vascular Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, USA.
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