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Mangiardi M, Bravi MC, Pezzella FR, Ricci L, Anticoli S. Unsuccessful Endovascular Treatment in a Patient With Stroke Onset of Takayasu Arteritis and Positive Clinical Outcome. Cureus 2020; 12:e11980. [PMID: 33425551 PMCID: PMC7788043 DOI: 10.7759/cureus.11980] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
Takayasu's arteritis (TA) is a chronic progressive vasculitis affecting large and medium-sized vessels, mainly in young subjects. It is most common in women with a higher prevalence in the Asian population. Stroke is a rare complication of TA, and these patients usually have a poor therapeutic response to revascularization treatments (thrombolysis and/or thrombectomy). We report a case of a male patient aged between 40 and 50 years admitted to our Emergency Department's Stroke Unit for sudden left hemiplegia, hypoesthesia, and dysarthria caused by right internal carotid artery (ICA), middle cerebral artery (MCA), and anterior cerebral artery (ACA) occlusion. He was treated with intravenous thrombolysis (r-tPA), endovascular carotid stenting, and thromboaspiration. We also revealed subclavian stenosis, vascular bruit, erythrocyte sedimentation rate (ESR), and C-reactive protein (CRP) elevation; therefore, a diagnosis of TA was made. Double antiplatelet therapy (DAPT) was started. Despite the early post-procedural carotid stent occlusion, the patient was discharged with a full recovery (neurological index of stroke scale [NIHSS] = 0). Thefive5-year clinical follow-up showed no clinical neurological relapses, and no arterial restenosis was found by further carotid artery echo-Doppler. Takayasu arteritis is a rare cause of ischemic stroke in young adults; however, stroke may be the first manifestation of the disease. Guidelines concerning the role of revascularization treatment in this type of patients are unclear. In this regard, the clinical experience and the multidisciplinary approach applied in our case had a pivotal role. Such an approach would eventually advocate for standardized treatment in patients with stroke and TA.
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Couture P, Chazal T, Rosso C, Haroche J, Léger A, Hervier B, Deltour S, Amoura Z, Cohen Aubart F. Cerebrovascular events in Takayasu arteritis: a multicenter case-controlled study. J Neurol 2018; 265:757-763. [PMID: 29392458 DOI: 10.1007/s00415-018-8744-8] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2017] [Revised: 11/26/2017] [Accepted: 01/09/2018] [Indexed: 11/29/2022]
Abstract
OBJECTIVES Takayasu arteritis (TA) is a giant cell arteritis usually affecting young women and characterized by inflammatory and ischemic signs of large vessel involvement, including extracranial cerebral arteries. The impact of stroke on TA prognosis has not been well evaluated. METHODS We performed a retrospective multicenter review of patients with definite TA who experienced at least one stroke and compared the findings to 17 matched patients with TA diagnosis without neurological involvement. RESULTS Seventeen patients (15 women, median age at stroke diagnosis 44 years) receiving a diagnosis of TA and stroke between 2002 and 2016 in our institution were included, from a cohort of 126 patients suffering from TA (13.5%). At diagnosis, patients from both groups had comparable cardiovascular risk factors. The first cerebrovascular event was ischemic stroke (n = 15) or transient ischemic attack (n = 2). In eight patients, stroke occurred after the TA diagnosis was made. In four patients, stroke occurred after carotid surgery. At the end of follow-up, 59% of patients had a neurological impairment, 35% had a recurrence of stroke, and 24% suffered from epilepsy. CONCLUSIONS Stroke is a major cause of disability in TA patients. Internal carotid surgery may be performed with caution because of the risk of stroke after the procedure.
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Affiliation(s)
- Priscille Couture
- Service de Médecine 2, Institut e3m, Centre National de Référence Maladies Systémiques Rares, Lupus systémique et Syndrome des Anticorps Antiphospholipides, Assistance Publique-Hôpitaux de Paris, Hôpital de la Pitié-Salpêtrière, 75013, Paris, France
| | - Thibaud Chazal
- Service de Médecine 2, Institut e3m, Centre National de Référence Maladies Systémiques Rares, Lupus systémique et Syndrome des Anticorps Antiphospholipides, Assistance Publique-Hôpitaux de Paris, Hôpital de la Pitié-Salpêtrière, 75013, Paris, France
| | - Charlotte Rosso
- Service de Neurologie vasculaire, Assistance Publique-Hôpitaux de Paris, Hôpital de la Pitié-Salpêtrière, 75013, Paris, France.,Sorbonne Université, Université Paris VI Pierre et Marie Curie, 75013, Paris, France
| | - Julien Haroche
- Service de Médecine 2, Institut e3m, Centre National de Référence Maladies Systémiques Rares, Lupus systémique et Syndrome des Anticorps Antiphospholipides, Assistance Publique-Hôpitaux de Paris, Hôpital de la Pitié-Salpêtrière, 75013, Paris, France.,Sorbonne Université, Université Paris VI Pierre et Marie Curie, 75013, Paris, France
| | - Anne Léger
- Service de Neurologie vasculaire, Assistance Publique-Hôpitaux de Paris, Hôpital de la Pitié-Salpêtrière, 75013, Paris, France
| | - Baptiste Hervier
- Département d'immunologie clinique, Assistance Publique-Hôpitaux de Paris, Hôpital de la Pitié-Salpêtrière, 75013, Paris, France
| | - Sandrine Deltour
- Service de Neurologie vasculaire, Assistance Publique-Hôpitaux de Paris, Hôpital de la Pitié-Salpêtrière, 75013, Paris, France
| | - Zahir Amoura
- Service de Médecine 2, Institut e3m, Centre National de Référence Maladies Systémiques Rares, Lupus systémique et Syndrome des Anticorps Antiphospholipides, Assistance Publique-Hôpitaux de Paris, Hôpital de la Pitié-Salpêtrière, 75013, Paris, France.,Sorbonne Université, Université Paris VI Pierre et Marie Curie, 75013, Paris, France
| | - Fleur Cohen Aubart
- Service de Médecine 2, Institut e3m, Centre National de Référence Maladies Systémiques Rares, Lupus systémique et Syndrome des Anticorps Antiphospholipides, Assistance Publique-Hôpitaux de Paris, Hôpital de la Pitié-Salpêtrière, 75013, Paris, France. .,Sorbonne Université, Université Paris VI Pierre et Marie Curie, 75013, Paris, France.
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Xiao Y, Zhou J, Wei X, Sun Y, Zhang L, Feng J, Feng R, Zhao Z, Jing Z. Outcomes of different treatments on Takayasu's arteritis. J Thorac Dis 2016; 8:2495-2503. [PMID: 27747001 DOI: 10.21037/jtd.2016.08.12] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
BACKGROUND Takayasu's arteritis (TA) is a nonspecific chronic inflammation of the aorta and its branches. This study compared the outcomes of surgical treatments including bypass surgery, cutting balloon angioplasty and conventional balloon angioplasty to TA patients exhibiting supra-aortic arterial (SAA). METHODS This retrospective study was conducted on 42 TA patients, obtained from hospital database, who underwent surgical therapy due to SAA lesions from January 2010 to March 2015. Ten patients were reconstructed using cutting balloon angioplasty, 16 patients received conventional balloon angioplasty and 16 patients from bypass surgery. The primary patency, recurrent symptoms, re-intervention, early (<30 days) and late complications associated with treatment were evaluated. RESULTS In the conventional balloon angioplasty group, two patients were converted to bypass surgery as the guidewire could not traverse the lesions. The follow-up at 30.07±17.96 months (range, 1-60 months) showed restenosis or occlusion development in 40.9% arteries in conventional balloon angioplasty, compared with 6.3% after bypass surgery (P=0.018). The restenosis or occlusion rate between cutting balloon angioplasty and conventional balloon angioplasty groups were insignificant (P=0.738). In the re-intervention, three out of four (75%) treated by cutting balloon angioplasty were patent as compared to the three out of nine arteries (33.3%) dealt with by conventional angioplasty that was patent (P=0.266). Intracerebral hemorrhage (n=1) was developed in the bypass surgery group. Mortality was not observed in any of the groups. CONCLUSIONS Cutting balloon angioplasty can be considered as a safe, effective, and less-invasive alternative for non-diffuse SAA lesions, especially in young TA patients. However, bypass surgery has better primary patency rate than endovascular treatment.
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Affiliation(s)
- Yu Xiao
- Department of Vascular Surgery, Changhai Hospital, Second Military Medical University, Shanghai 200433, China
| | - Jian Zhou
- Department of Vascular Surgery, Changhai Hospital, Second Military Medical University, Shanghai 200433, China
| | - Xiaolong Wei
- Department of Vascular Surgery, Changhai Hospital, Second Military Medical University, Shanghai 200433, China
| | - Yudong Sun
- Department of Vascular Surgery, Changhai Hospital, Second Military Medical University, Shanghai 200433, China
| | - Lei Zhang
- Department of Vascular Surgery, Changhai Hospital, Second Military Medical University, Shanghai 200433, China
| | - Jiaxuan Feng
- Department of Vascular Surgery, Changhai Hospital, Second Military Medical University, Shanghai 200433, China
| | - Rui Feng
- Department of Vascular Surgery, Changhai Hospital, Second Military Medical University, Shanghai 200433, China
| | - Zhiqing Zhao
- Department of Vascular Surgery, Changhai Hospital, Second Military Medical University, Shanghai 200433, China
| | - Zaiping Jing
- Department of Vascular Surgery, Changhai Hospital, Second Military Medical University, Shanghai 200433, China
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Stent placement for treatment of long-segment (≥40 mm) carotid atherosclerotic stenosis: results and long-term follow-up in a single-center experience. Clin Neurol Neurosurg 2014; 124:32-6. [PMID: 25014133 DOI: 10.1016/j.clineuro.2014.06.025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2014] [Revised: 06/11/2014] [Accepted: 06/15/2014] [Indexed: 11/22/2022]
Abstract
BACKGROUND Treatment of long segment carotid stenosis (≥40 mm) with carotid artery stenting (CAS) has rarely been reported. In randomized trials, use of longer stents (>40 mm) has been associated with adverse clinical events. Here, we report our preliminary experience on the stent length and outcome in treating long segment carotid arterial stenosis. METHODS AND RESULTS Between August 2003 and February 2013, 22 patients with long segment stenosis of the carotid artery were treated by CAS. The mean stent length was 58.5 mm (50-60 mm). The procedures were successful in all patients, and all reported remarkable relief of symptoms immediately after stent placement. Complications included 1 case of cerebral hemorrhage and one death from myocardial infarction at 10 months. The mean follow up was 27.3 months (10-60 months). One follow-up was lost. 2 patients had late stent thrombosis at 22 and 36 months by CTA follow-up. 18 patients had persistent relief, and angiography/CTA showed normal carotid flow. CONCLUSIONS Our study showed that stenting for long carotid stenosis (≥40 mm) can be beneficial. Large scale clinical trial is needed to further evaluate its efficacy and safety.
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Diagnosis and assessment of disease activity in takayasu arteritis: a childhood case illustrating the challenge. Case Rep Rheumatol 2014; 2014:603171. [PMID: 24511407 PMCID: PMC3913344 DOI: 10.1155/2014/603171] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2013] [Accepted: 10/28/2013] [Indexed: 11/17/2022] Open
Abstract
Takayasu Arteritis (TA) is a rare, debilitating large vessel vasculitis occurring in patients of all ages, including infants, but the disease most commonly presents in the third decade. Diagnosis is often delayed and consequently TA is associated with significant morbidity and mortality. Accurate methods of monitoring disease activity or damage are lacking and currently rely on a combination of clinical features, blood inflammatory markers, and imaging modalities. In this report we describe a case of a 14-year-old boy with childhood-onset TA who, despite extensive negative investigations, did indeed have on-going active large vessel vasculitis with fatal outcome. Postmortem analysis demonstrated more extensive and active disease than originally identified. This report illustrates and discusses the limitations of current modalities for the detection and monitoring of disease activity and damage in large vessel vasculitis. Clinicians must be aware of these limitations and challenges if we are to strive for better outcomes in TA.
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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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