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El Hunjul GN, Cazzaniga J, Navarro Gonzalez J, Quinonez J, Ruxmohan S, Fahs A. A Case of Takayasu's Arteritis Presenting With Acute Middle Cerebral Artery Stroke Managed With Aortic-Common Carotid Artery (CCA) Bypass Surgery. Cureus 2023; 15:e48166. [PMID: 38046774 PMCID: PMC10693388 DOI: 10.7759/cureus.48166] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2023] [Accepted: 11/02/2023] [Indexed: 12/05/2023] Open
Abstract
Takayasu's arteritis (TA) is a rare inflammatory disorder that affects large arteries, particularly the aorta and its main branches. TA is also known as a pulseless disease because it diminishes blood flow to the limbs and organs. The patient was a 17-year-old female whose prior medical history included a diagnosis of TA. She had been experiencing multiple syncopal episodes up to three times daily, lasting 10 seconds each. She was being managed outpatient with immunologic therapy and warfarin. She initially presented to a children's hospital with abdominal pain and an asymmetrical smile and was found to have a ruptured ovarian cyst. This case demonstrated that life-threatening complications of TA can occur as a result of otherwise unrelated and common circumstances. The patient was managed medically and then proceeded to surgery. The case further highlights the multidisciplinary team approach between medical and surgical specialties and weighing the risks and benefits of complications for the patient's long-term care. Early diagnosis and prompt initiation of appropriate therapy are essential for better outcomes. Clinicians should be aware of the nonspecific symptoms of TA and consider it in the differential diagnosis of young patients presenting with systemic symptoms and arterial insufficiency. The initial presentation of middle cerebral artery stroke in young women has been documented in prior literature, but most published cases present the medical management of the disease. Our patient's case was unique because medical management was insufficient, with surgical management pursued due to persistent symptomatic hypotension. The inciting event of this case, an ovarian rupture with retroperitoneal hemorrhage, represents a unique burden to watershed infarctions in this patient group. Further research is needed to understand the pathogenesis of TA better and to develop more effective treatment strategies for this challenging disease.
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Affiliation(s)
| | - Juliana Cazzaniga
- Neurology, Florida International University, Herbert Wertheim College of Medicine, Miami, USA
| | | | - Jonathan Quinonez
- Osteopathic Medicine/Neurology, Larkin Community Hospital Palm Springs Campus, Hialeah, USA
- Addiction Medicine, Brandon Regional Hospital, Brandon, USA
| | - Samir Ruxmohan
- Neurocritical Care, University of Texas (UT) Southwestern Medical Center, Dallas, USA
| | - Abrahim Fahs
- Addiction Medicine, Brandon Regional Hospital, Brandon, USA
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Yadav B, Sapkota A, Sharma S, Karmacharya RM, Vaidya S. Treating upper limb claudication in a patient with Takayasu's arteritis with carotid-to-subclavian bypass: A case report. Int J Surg Case Rep 2023; 109:108566. [PMID: 37549437 PMCID: PMC10425891 DOI: 10.1016/j.ijscr.2023.108566] [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: 06/14/2023] [Revised: 07/20/2023] [Accepted: 07/23/2023] [Indexed: 08/09/2023] Open
Abstract
INTRODUCTION AND IMPORTANCE Takayasu's Arteritis (TA) is a rare form of large vessel vasculitis often being apparent late in its progression with features of artery occlusion. Studies comparing endovascular approach with bypass surgeries reveal surgery to be a better option with lesser rates of postoperative restenosis. CLINICAL PRESENTATION A 25-year-old female patient presented with dizziness, headache, claudication and paresthesias in the right arm. Her right radial pulse couldn't be appreciated and BP on the right brachial artery was unrecordable. BP on her left brachial artery was 160/110 mmHg. CT angiogram demonstrated stenosis in the right subclavian, coeliac and left renal artery. After adequate control of hypertension and ruling out the active phase of TA, she underwent right carotid to subclavian bypass with Polytetrafluoroethylene(PTFE) graft. At 1 year follow up there was significant improvement in her right arm claudication. DISCUSSION Symptomatic cases of TA need either endovascular angioplasty or surgical intervention to establish reperfusion. Surgery must be done only in the inactive phase of the disease because of the risk of reocclusion. The remission of TA is difficult to predict with clinical findings and ESR values. Oftentimes biopsies taken from the arteries of patients who underwent surgery showed features of active inflammation. CONCLUSION We recommend all cases of TA to be treated with a course of steroids before planning for surgery irrespective of symptomatology and ESR values. Bypass surgeries with PTFE graft along with preoperative or postoperative steroid therapy result in resolution of ischemic symptoms.
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Affiliation(s)
- Binay Yadav
- Department of Cardiothoracic and Vascular Surgery, Dhulikhel Hospital, Dhulikhel, Kavre, Nepal.
| | - Anugya Sapkota
- Kathmandu University School of Medical Sciences, Dhulikhel, Kavre, Nepal
| | - Sanjay Sharma
- Department of Cardiothoracic and Vascular Surgery, Dhulikhel Hospital, Dhulikhel, Kavre, Nepal
| | - Robin Man Karmacharya
- Department of Cardiothoracic and Vascular Surgery, Dhulikhel Hospital, Dhulikhel, Kavre, Nepal
| | - Satish Vaidya
- Department of Cardiothoracic and Vascular Surgery, Dhulikhel Hospital, Dhulikhel, Kavre, Nepal
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Adili D, Cai D, Wu B, Yu H, Gu Y, Zhang Y, Shi H. An exploration of the feasibility and clinical value of half-dose 5-h total-body 18F-FDG PET/CT scan in patients with Takayasu arteritis. Eur J Nucl Med Mol Imaging 2023; 50:2375-2385. [PMID: 36864361 DOI: 10.1007/s00259-023-06168-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2022] [Accepted: 02/18/2023] [Indexed: 03/04/2023]
Abstract
PURPOSE To explore the feasibility and clinical value of 5-h delayed 18F-fluorodeoxyglucose (18F-FDG) total-body (TB) positron emission tomography/computed tomography (PET/CT) in patients with Takayasu arteritis (TA). METHODS This study included nine healthy volunteers who underwent 1-, 2.5-, and 5-h triple-time TB PET/CT scans and 55 patients with TA who underwent 2- and 5-h dual-time TB PET/CT scans with 1.85 MBq/kg 18F-FDG. The liver, blood pool, and gluteus maximus muscle signal-to-noise ratios (SNRs) were calculated by dividing the SUVmean by its standard deviation to evaluate imaging quality. TA lesions' 18F-FDG uptake was graded on a three-point scale (I, II, III), with grades II and III considered positive lesions. Lesion-to-blood maximum standardised uptake value (SUVmax) ratio (LBR) was calculated by dividing the lesion SUVmax by the blood pool SUVmax. RESULTS The liver, blood pool, and muscle SNR of the healthy volunteers at 2.5- and 5-h were similar (0.117 and 0.115, respectively, p = 0.095). We detected 415 TA lesions in 39 patients with active TA. The average 2- and 5-h scan LBRs were 3.67 and 7.59, respectively (p < 0.001). Similar TA lesion detection rates were noted in the 2-h (92.0%; 382/415) and 5-h (94.2%; 391/415) scans (p = 0.140). We detected 143 TA lesions in 19 patients with inactive TA. The 2- and 5-h scan LBRs were 2.99 and 5.71, respectively (p < 0.001). Similar positive detection rates in inactive TA were noted in the 2-h (97.9%; 140/143) and 5-h (98.6%; 141/143) scans (p = 0.500). CONCLUSION The 2- and 5-h 18F-FDG TB PET/CT scans had similar positive detection rates, but both combined could better detect inflammatory lesions in patients with TA.
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Affiliation(s)
- Dilibire Adili
- Department of Nuclear Medicine, Zhongshan Hospital, Fudan University, Shanghai, 200032, China
- Nuclear Medicine Institute of Fudan University, Shanghai, 200032, China
- Shanghai Institute of Medical Imaging, Shanghai, 200032, China
- Cancer Prevention and Treatment Center, Zhongshan Hospital, Fudan University, Shanghai, 200032, China
| | - Danjie Cai
- Department of Nuclear Medicine, Zhongshan Hospital, Fudan University, Shanghai, 200032, China
- Nuclear Medicine Institute of Fudan University, Shanghai, 200032, China
- Shanghai Institute of Medical Imaging, Shanghai, 200032, China
- Cancer Prevention and Treatment Center, Zhongshan Hospital, Fudan University, Shanghai, 200032, China
| | - Bing Wu
- Department of Nuclear Medicine, Zhongshan Hospital, Fudan University, Shanghai, 200032, China
- Nuclear Medicine Institute of Fudan University, Shanghai, 200032, China
- Shanghai Institute of Medical Imaging, Shanghai, 200032, China
- Cancer Prevention and Treatment Center, Zhongshan Hospital, Fudan University, Shanghai, 200032, China
| | - Haojun Yu
- Department of Nuclear Medicine, Zhongshan Hospital, Fudan University, Shanghai, 200032, China
- Nuclear Medicine Institute of Fudan University, Shanghai, 200032, China
- Shanghai Institute of Medical Imaging, Shanghai, 200032, China
- Cancer Prevention and Treatment Center, Zhongshan Hospital, Fudan University, Shanghai, 200032, China
| | - Yushen Gu
- Department of Nuclear Medicine, Zhongshan Hospital, Fudan University, Shanghai, 200032, China
- Nuclear Medicine Institute of Fudan University, Shanghai, 200032, China
- Shanghai Institute of Medical Imaging, Shanghai, 200032, China
- Cancer Prevention and Treatment Center, Zhongshan Hospital, Fudan University, Shanghai, 200032, China
| | - Yiqiu Zhang
- Department of Nuclear Medicine, Zhongshan Hospital, Fudan University, Shanghai, 200032, China.
- Nuclear Medicine Institute of Fudan University, Shanghai, 200032, China.
- Shanghai Institute of Medical Imaging, Shanghai, 200032, China.
- Cancer Prevention and Treatment Center, Zhongshan Hospital, Fudan University, Shanghai, 200032, China.
| | - Hongcheng Shi
- Department of Nuclear Medicine, Zhongshan Hospital, Fudan University, Shanghai, 200032, China.
- Nuclear Medicine Institute of Fudan University, Shanghai, 200032, China.
- Shanghai Institute of Medical Imaging, Shanghai, 200032, China.
- Cancer Prevention and Treatment Center, Zhongshan Hospital, Fudan University, Shanghai, 200032, China.
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Wen D, Feng L, Du X, Dong JZ, Ma CS. Biomarkers in Takayasu arteritis. Int J Cardiol 2023; 371:413-417. [PMID: 36067923 DOI: 10.1016/j.ijcard.2022.08.058] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/07/2022] [Revised: 08/08/2022] [Accepted: 08/30/2022] [Indexed: 12/14/2022]
Abstract
Takayasu arteritis (TA) is a rare large vasculitis with unknown etiology, which affects the aorta and its primary branches, as well as the pulmonary and coronary arteries. Cellular and humoral immunity, chronic inflammation, and genetic factors are involved into TA pathogenesis. Several biomarkers, such as MMPs, TIMPs, cytokines, cell adhesion molecules, autoantibodies, complements, PTX3, sRAGE, NT-proBNP, 8-isoPGF2α, NO2-, acute-phase and immunology-related proteins, thrombogenicity markers, ghrelin leptin and adipokines, endothelial damage and repair factors, genetic markers etc., related to the pathogenesis could be observed in patients with TA. These biomarkers have revealed great values in early diagnosis, evaluating disease activity, guiding clinical treatment options, and thus demonstrated significant clinical application values in TA. The combination of biomarkers assay and imaging examination may detect TA more accurately. The aim of this review is to systemically observe the clinical significance of these biomarkers in TA.
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Affiliation(s)
- Dan Wen
- Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University, National Clinical Research Center for Cardiovascular Diseases, Beijing, China
| | - Li Feng
- Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University, National Clinical Research Center for Cardiovascular Diseases, Beijing, China
| | - Xin Du
- Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University, National Clinical Research Center for Cardiovascular Diseases, Beijing, China
| | - Jian-Zeng Dong
- Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University, National Clinical Research Center for Cardiovascular Diseases, Beijing, China
| | - Chang-Sheng Ma
- Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University, National Clinical Research Center for Cardiovascular Diseases, Beijing, China.
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Coşkun C, Kardaş RC, Küçük H. Coexistence of 3q29 microdeletion syndrome and Takayasu arteritis: A case report. Int J Rheum Dis 2022; 26:778-780. [PMID: 36502530 DOI: 10.1111/1756-185x.14515] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2022] [Revised: 10/13/2022] [Accepted: 11/06/2022] [Indexed: 12/14/2022]
Abstract
Takayasu arteritis (TAK) is a rare type of large and medial vessel systemic vasculitis. A variety of factors are thought to play a role in the occurrence and development of TAK such as human leukocyte antigen-B52, autoimmunity, inflammation and environmental factors. 3q29 microdeletion syndrome is also a very rare inherited disease, which includes intellectual disability, growth retardation and neuropsychiatric disorders. Here, we present a case with concomitant TAK and 3q29 microdeletion syndrome. A 22-year-old woman presented to the emergency department with sudden bilateral vision loss and severe headache. During physical examination, the patient was noted to have a difference in blood pressure between extremities. Computed tomography angiography revealed vascular wall inflammation in the abdominal aorta. Based on clinical and radiographical findings, a diagnosis of TAK was made. Concurrently, the patient was found to have short stature and intellectual disability. A possible genetic etiology was sought out. Chromosome analysis showed a 1.5 Mb heterozygous deletion on chromosome 3 and a diagnosis of 3q29 microdeletion was made. Additional imaging also revealed a split cord in medulla spinalis along with hemivertebrae and fusion anomalies, neither of which were reported in TAK or 3q29 microdeletion cases in the literature.
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Affiliation(s)
- Cansu Coşkun
- Department of Internal Medicine Gazi University Faculty of Medicine Ankara Turkey
| | - Rıza Can Kardaş
- Division of Rheumatology, Department of Internal Medicine Gazi University Faculty of Medicine Ankara Turkey
| | - Hamit Küçük
- Division of Rheumatology, Department of Internal Medicine Gazi University Faculty of Medicine Ankara Turkey
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Huo J, Wang B, Yu L, Gao D, Cheng R, Wang J, Zhou X, Tian T, Gao L. Clinical characteristics and outcomes in patients with Takayasu arteritis coexisting with myocardial ischemia and neurological symptoms: A multicenter, long-term, follow-up study. Front Cardiovasc Med 2022; 9:948124. [PMID: 35990973 PMCID: PMC9385106 DOI: 10.3389/fcvm.2022.948124] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2022] [Accepted: 07/11/2022] [Indexed: 11/13/2022] Open
Abstract
BackgroundThe incidence of coexisting myocardial ischemia and neurological symptoms in Takayasu arteritis (TA) is currently unknown. There is no standardized treatment algorithm in complex cases involving the coronary and intracranial arteries.ObjectiveThis study aimed to describe the clinical characteristics and outcomes in patients with TA coexisting with myocardial ischemia and neurological symptoms.MethodsWe retrospectively collected and assessed 1,580 patients with TA, and enrolled patients with myocardial ischemia and neurological symptoms from January 2002 to December 2021 in several hospitals. The incidence, clinical features, management strategy, and prognosis of these patients were evaluated.ResultsNinety-four (5.9%, 94/1,580) patients with TA coexisting with myocardial ischemia and neurological symptoms were included in the present study. Imaging results showed that the subclavian arteries were the most frequently affected arteries and 37 patients had intracranial vascular abnormalities, comprising the basilar artery (6.1%, 17/279), middle cerebral artery (2.5%, 7/279), anterior cerebral artery (2.9%, 8/279), and posterior cerebral artery (1.9%, 5/279). Among patients with neurological symptoms, 25 patients underwent percutaneous transluminal angioplasty and 20 patients underwent stent implantation. The most common site of stenosis was the ostial and proximal segments of the coronary artery, with 142 lesions among 188 (75.5%) lesions. Thirty-eight patients adopted interventional therapy, 21 patients underwent surgical treatment, and the remaining 35 patients received conservative treatment. There were 20 (21.27%, 20/94) late deaths during a mean follow-up of 57.79 months. The mortality rate in the conservative treatment group was significantly higher than that in the interventional therapy and surgical treatment groups.ConclusionPatients with TA involving both the coronary and intracranial vessels are not rare. Stenosis and occlusion lesions most frequently involve the ostia and proximal segment of the arteries. Severe vascular lesions should be revascularized as soon as possible. These patients should be supplemented with glucocorticoids, antiplatelet, nitrates, and statins.
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Affiliation(s)
- Junting Huo
- Department of Neurology, Affiliated Chuiyangliu Hospital of Tsinghua University, Beijing, China
| | - Bin Wang
- Department of Comprehensive Surgery, General Hospital of Chinese People’s Liberation Army and National Clinical Research Center for Geriatric Disease, Beijing, China
| | - LiJun Yu
- Department of Comprehensive Surgery, General Hospital of Chinese People’s Liberation Army and National Clinical Research Center for Geriatric Disease, Beijing, China
| | - Dewei Gao
- Department of Comprehensive Surgery, General Hospital of Chinese People’s Liberation Army and National Clinical Research Center for Geriatric Disease, Beijing, China
| | - Rui Cheng
- Department of Comprehensive Surgery, General Hospital of Chinese People’s Liberation Army and National Clinical Research Center for Geriatric Disease, Beijing, China
| | - Jiawei Wang
- Department of Neurology, Beijing Tongren Hospital of Capital Medical University, Beijing, China
| | - Xianliang Zhou
- Department of Cardiology, FuWai Hospital and Cardiovascular Institute, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Tao Tian
- Department of Cardiology, FuWai Hospital and Cardiovascular Institute, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
- *Correspondence: Tao Tian,
| | - Linggen Gao
- Department of Comprehensive Surgery, General Hospital of Chinese People’s Liberation Army and National Clinical Research Center for Geriatric Disease, Beijing, China
- Linggen Gao,
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Cicco S, Desantis V, Vacca A, Cazzato G, Solimando AG, Cirulli A, Noviello S, Susca C, Prete M, Brosolo G, Catena C, Lamanuzzi A, Saltarella I, Frassanito MA, Cimmino A, Ingravallo G, Resta L, Ria R, Montagnani M. Cardiovascular Risk in Patients With Takayasu Arteritis Directly Correlates With Diastolic Dysfunction and Inflammatory Cell Infiltration in the Vessel Wall: A Clinical, ex vivo and in vitro Analysis. Front Med (Lausanne) 2022; 9:863150. [PMID: 35652080 PMCID: PMC9149422 DOI: 10.3389/fmed.2022.863150] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2022] [Accepted: 04/11/2022] [Indexed: 12/24/2022] Open
Abstract
Background Takayasu Arteritis (TAK) increases vascular stiffness and arterial resistance. Atherosclerosis leads to similar changes. We investigated possible differences in cardiovascular remodeling between these diseases and whether the differences are correlated with immune cell expression. Methods Patients with active TAK arteritis were compared with age- and sex-matched atherosclerotic patients (Controls). In a subpopulation of TAK patients, Treg/Th17 cells were measured before (T0) and after 18 months (T18) of infliximab treatment. Echocardiogram, supraaortic Doppler ultrasound, and lymphocytogram were performed in all patients. Histological and immunohistochemical changes of the vessel wall were evaluated as well. Results TAK patients have increased aortic valve dysfunction and diastolic dysfunction. The degree of dysfunction appears associated with uric acid levels. A significant increase in aortic stiffness was also observed and associated with levels of peripheral T lymphocytes. CD3+ CD4+ cell infiltrates were detected in the vessel wall samples of TAK patients, whose mean percentage of Tregs was lower than Controls at T0, but increased significantly at T18. Opposite behavior was observed for Th17 cells. Finally, TAK patients were found to have an increased risk of atherosclerotic cardiovascular disease (ASCVD). Conclusion Our data suggest that different pathogenic mechanisms underlie vessel damage, including atherosclerosis, in TAK patients compared with Controls. The increased risk of ASCVD in TAK patients correlates directly with the degree of inflammatory cell infiltration in the vessel wall. Infliximab restores the normal frequency of Tregs/Th17 in TAK patients and allows a possible reduction of steroids and immunosuppressants.
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Affiliation(s)
- Sebastiano Cicco
- Department of Biomedical Sciences and Human Oncology (DIMO), Unit of Internal Medicine and Clinical Oncology, University of Bari Aldo Moro Medical School, Bari, Italy
| | - Vanessa Desantis
- Department of Biomedical Sciences and Human Oncology (DIMO), Unit of Internal Medicine and Clinical Oncology, University of Bari Aldo Moro Medical School, Bari, Italy.,Department of Biomedical Sciences and Human Oncology, Pharmacology Section, University of Bari Aldo Moro Medical School, Bari, Italy
| | - Antonio Vacca
- Division of Internal Medicine, Department of Medicine, University of Udine, Udine, Italy
| | - Gerardo Cazzato
- Section of Pathology, Department of Emergency and Organ Transplantation, University of Bari Aldo Moro, Bari, Italy
| | - Antonio G Solimando
- Department of Biomedical Sciences and Human Oncology (DIMO), Unit of Internal Medicine and Clinical Oncology, University of Bari Aldo Moro Medical School, Bari, Italy
| | - Anna Cirulli
- Department of Biomedical Sciences and Human Oncology (DIMO), Unit of Internal Medicine and Clinical Oncology, University of Bari Aldo Moro Medical School, Bari, Italy
| | - Silvia Noviello
- Department of Biomedical Sciences and Human Oncology (DIMO), Unit of Internal Medicine and Clinical Oncology, University of Bari Aldo Moro Medical School, Bari, Italy
| | - Cecilia Susca
- Department of Admission and Emergency Medicine and Surgery, "S. Maria degli Angeli" Hospital, Azienda Sanitaria Locale (ASL) Bari, Bari, Italy
| | - Marcella Prete
- Department of Biomedical Sciences and Human Oncology (DIMO), Unit of Internal Medicine and Clinical Oncology, University of Bari Aldo Moro Medical School, Bari, Italy
| | - Gabriele Brosolo
- Division of Internal Medicine, Department of Medicine, University of Udine, Udine, Italy
| | - Cristiana Catena
- Division of Internal Medicine, Department of Medicine, University of Udine, Udine, Italy
| | - Aurelia Lamanuzzi
- Department of Biomedical Sciences and Human Oncology (DIMO), Unit of Internal Medicine and Clinical Oncology, University of Bari Aldo Moro Medical School, Bari, Italy
| | - Ilaria Saltarella
- Department of Biomedical Sciences and Human Oncology (DIMO), Unit of Internal Medicine and Clinical Oncology, University of Bari Aldo Moro Medical School, Bari, Italy
| | - Maria Antonia Frassanito
- Department of Biomedical Sciences and Human Oncology (DIMO), General Pathology Unit, University of Bari Aldo Moro Medical School, Bari, Italy
| | - Antonella Cimmino
- Section of Pathology, Department of Emergency and Organ Transplantation, University of Bari Aldo Moro, Bari, Italy
| | - Giuseppe Ingravallo
- Section of Pathology, Department of Emergency and Organ Transplantation, University of Bari Aldo Moro, Bari, Italy
| | - Leonardo Resta
- Section of Pathology, Department of Emergency and Organ Transplantation, University of Bari Aldo Moro, Bari, Italy
| | - Roberto Ria
- Department of Biomedical Sciences and Human Oncology (DIMO), Unit of Internal Medicine and Clinical Oncology, University of Bari Aldo Moro Medical School, Bari, Italy
| | - Monica Montagnani
- Department of Biomedical Sciences and Human Oncology, Pharmacology Section, University of Bari Aldo Moro Medical School, Bari, Italy
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Kant S, Bajpai J, Bajaj D, S Kushwaha RA, Pradhan A, Verma A, Verma S. A rare cause of hemoptysis in a young female. JOURNAL OF MEDICAL SCIENCES 2022. [DOI: 10.4103/jmedsci.jmedsci_300_20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
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Khajali Z, Seilani P, Pouraliakbar H, Parsaee M, Akbari Parsa N. A case of Takayasu arteritis mimicking aortic coarctation. J Cardiol Cases 2021; 24:237-239. [PMID: 34868405 DOI: 10.1016/j.jccase.2021.04.010] [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: 01/22/2021] [Revised: 04/06/2021] [Accepted: 04/14/2021] [Indexed: 10/21/2022] Open
Abstract
A 23-year-old woman with history of tetralogy of Fallot presented with new hypertension and constitutional symptoms first diagnosed as coartation of aorta based on primary imaging but that turned out to be Takayasu arteritis after more evaluation by laboratory data and complementary imaging modalities . <Learning objective: Inflammatory vasculitis involving large vessels such as Takayasu arteritis might mimic congenital structural heart diseases like aortic coarctation in rare cases due to post inflammatory strictures in thoracic aorta and aortic arch main branches. This report demonstrates the importance of history taking, physical examination, and using different imaging modalities for the most accurate diagnosis.>.
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Affiliation(s)
- Zahra Khajali
- Rajaee Cardiovascular Medical and Research Center, Tehran, Iran
| | - Parisa Seilani
- Rajaee Cardiovascular Medical and Research Center, Tehran, Iran
| | | | - Mozhgan Parsaee
- Rajaee Cardiovascular Medical and Research Center, Tehran, Iran
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Alobo G, Nahurira V, Omona V, Bayo P, Olum S. Refractory convulsive syncope in pregnancy: a rare presentation of Takayasu's arteritis - a case report and literature review. Afr Health Sci 2021; 21:852-857. [PMID: 34795744 PMCID: PMC8568231 DOI: 10.4314/ahs.v21i2.46] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND Neurological manifestation of Takayasu's Arteritis (TA) in pregnancy presenting as convulsive syncope is extremely rare, and poses a serious diagnostic dilemma due to other vast causes of fits in pregnancy. OBJECTIVE We aimed to present and shed more light on a case of TA with convulsive syncope in pregnancy refractory to anticonvulsants for seven weeks, and review the literature on the management of TA in pregnancy. CASE PRESENTATION A gravida 4 para 3+0 at 28 weeks of amenorrhea presented with repeated episodes of the sudden loss of consciousness, followed by a fall and jerking of the limbs. These were refractory to anticonvulsants that she had used for seven weeks. Physical examination revealed undetectable pulse and blood pressure (BP) in the upper limbs but elevated BP in the lower limbs. Further investigations confirmed TA and she improved on steroids and antihypertensives. CONCLUSION This case typically describes the unexpected presentation of TA with convulsive syncope. It calls for meticulous clinical assessment of epileptic seizures in pregnancy to avoid a late diagnosis of TA and its potential poor outcomes.
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Affiliation(s)
- Gasthony Alobo
- Department of Obstetrics and Gynecology, Lacor Hospital, Gulu, Uganda
- Department of Obstetrics and Gynecology, Lira University, Lira Uganda
| | - Violah Nahurira
- Department of Obstetrics and Gynecology, Lacor Hospital, Gulu, Uganda
| | - Venice Omona
- Department of Pediatrics and Neurology, Lacor Hospital, Gulu, Uganda
| | - Pontius Bayo
- Department of Obstetrics and Gynecology, Lacor Hospital, Gulu, Uganda
| | - Sam Olum
- Department of Internal Medicine, Gulu University, Gulu, Uganda
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Pulse wave velocity, carotid intima media thickness and flow-mediated dilation in Takayasu arteritis: a systematic review. ACTA ACUST UNITED AC 2021; 6:e79-e84. [PMID: 34027216 PMCID: PMC8117071 DOI: 10.5114/amsad.2021.105390] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2021] [Accepted: 03/16/2021] [Indexed: 11/17/2022]
Abstract
Introduction Takayasu arteritis (TA) is a chronic vasculitis associated with an increased cardiovascular risk. The measurement of pulse wave velocity (PWV), carotid artery intima-media thickness (CIMT) and flow-mediated dilatation (FMD) are generally used for evaluating the cardiovascular risk. The application of these measurements to TA patients remains undetermined. Material and methods Clinical studies that reported the PWV, CIMT and FMD levels in TA patients, which were published prior to 2021, were summarized using PubMed. Results Fifteen studies were eligible. Overall, in TA patients, the PWV and CIMT levels were significantly higher and the FMD levels were significantly lower compared to controls. Part of the studies showed that the disease activity of TA was significantly associated with the PWV, CIMT or FMD levels. Conclusions The PWV, CIMT and FMD measurements could be useful for evaluating the cardiovascular risk in TA patients. Further studies to determine the proper use of these measurements are warranted.
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Chen ST, Luo CB, Guo WY, Chang FC. Endovascular management of symptomatic stenosis of supra-aortic arteries in patients with Takayasu arteritis. J Chin Med Assoc 2021; 84:303-308. [PMID: 33350653 DOI: 10.1097/jcma.0000000000000479] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND Endovascular management is used to treat Takayasu arteritis (TA) involving the supra-aortic branches. However, the long-term outcome of this treatment remains unclear. Here, technical safety, outcomes, and restenosis management of supra-aortic arteries in TA patients receiving endovascular treatment were evaluated. METHODS TA patients with symptomatic supra-aortic stenosis who underwent percutaneous angioplasty and stenting between 2008 and 2018 at our institute were enrolled in this study. Pre- and post-procedural magnetic resonance imaging (MRI) evaluations, including high-resolution vessel wall imaging (HR-VWI), were performed. Technical efficacy, peri-procedural complications, early post-procedural MRI results, and stent patency were examined. RESULTS All six patients successfully received stent placement or percutaneous transluminal angioplasty in a total of 22 treated arteries without neurologic complications. During follow-up (mean, 56.3 ± 41.1 months), no recurrent stroke occurred, yet significant restenosis developed in 12 of 22 (54.5%) of the treated arteries. Three of the patients underwent HR-VWI before surgery. Concentric wall thickening and enhancement of the left common carotid artery was detected in one patient, indicating acute inflammation. Angioplasty with drug-eluting balloon (DEB) successfully treated a case of refractory restenosis. Among 10 early post-procedure MRI performed, only two asymptomatic new lesions were detected with diffusion-weighted imaging. CONCLUSION Endovascular treatment of supra-aortic arteries of TA patients was safe and effective, yet was associated with a high restenosis rate. Thus, close follow-up is needed. HR-VWI is helpful for pre-procedural selection of patients for percutaneous angioplasty and stenting and drug-eluting balloon angioplasty appears to be a promising treatment for refractory in-stent restenosis.
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Affiliation(s)
- Shu-Ting Chen
- Department of Radiology, Taipei Veterans General Hospital, Taipei, Taiwan, ROC
- School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan, ROC
| | - Chao-Bao Luo
- Department of Radiology, Taipei Veterans General Hospital, Taipei, Taiwan, ROC
- School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan, ROC
| | - Wan-Yuo Guo
- Department of Radiology, Taipei Veterans General Hospital, Taipei, Taiwan, ROC
- School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan, ROC
| | - Feng-Chi Chang
- Department of Radiology, Taipei Veterans General Hospital, Taipei, Taiwan, ROC
- School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan, ROC
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Callen A, Narvid J, Chen X, Gregath T, Meisel K. Neurovascular disease, diagnosis, and therapy: Cervical and intracranial atherosclerosis, vasculitis, and vasculopathy. HANDBOOK OF CLINICAL NEUROLOGY 2021; 176:249-266. [PMID: 33272399 DOI: 10.1016/b978-0-444-64034-5.00023-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
Stroke is a leading cause of death, disability, and financial burden in the United States. Perhaps more than any other disease process, the rapidity with which the diagnosis and treatment of stroke are successfully achieved is paramount to the reduction of its associated morbidity and mortality. Steno-occlusive intracranial vascular disease, the most notorious culprit of cerebral ischemia and/or hemorrhage, traces its etiology to native and embolic atherosclerosis as well as various forms of vascular inflammation, insult, and dysfunction. Distinguishing between these causes is a critical first step in the diagnosis and treatment of a patient presenting with cerebrovascular compromise. In this chapter, we delineate the clinical and imaging features of cervical and intracranial atherosclerosis, vasculitis, and vasculopathy, along with the evidence behind the treatments which comprise their current-day standard of care. The modern imaging armamentarium is diverse and complex, with contrast-enhanced and non-contrast MR angiography, CT angiography, digital subtraction angiography, and ultrasound; each playing an important role in providing rapid insight into the patient's disease process. Understanding these imaging techniques and their application in the acute setting is critical for the provider caring for stroke patients.
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Affiliation(s)
- Andrew Callen
- Department of Radiology, University of Colorado, Boulder, CO, United States
| | - Jared Narvid
- Department of Radiology, University of California San Francisco, San Francisco, CA, United States
| | - Xiaolin Chen
- Department of Neurosurgery, Peking University International Hospital, Beijing, China
| | - Trevor Gregath
- Department of Neurology, Bryan Health, Lincoln, NE, United States
| | - Karl Meisel
- Department of Neurology, University of California San Francisco, San Francisco, CA, United States.
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Shumy F, Anam A, Choudhury M, Shahin M, Haq S, Amin M, Minhaj S. Rate and predictors of response to glucocorticoid therapy in patients of takayasu arteritis at a tertiary level hospital of Bangladesh: A longitudinal study. INDIAN JOURNAL OF RHEUMATOLOGY 2021. [DOI: 10.4103/injr.injr_40_21] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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Javadi Parvaneh V, Jari M, Rahmani K, Azma R, Shiari R. Five-day fever: The main presentation of childhood-onset Takayasu arteritis. Clin Case Rep 2020; 8:2361-2365. [PMID: 33363741 PMCID: PMC7752334 DOI: 10.1002/ccr3.3148] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2020] [Revised: 06/10/2020] [Accepted: 06/21/2020] [Indexed: 11/11/2022] Open
Abstract
In children with a nonspecific constitutional presentation such as prolonged fever, the physician should pay attention to primary vasculitides after ruling out the more common diseases such as infectious diseases, malignancies, and the other rheumatic disorders. The past history of autoimmunity may be a clue for this.
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Affiliation(s)
- Vadood Javadi Parvaneh
- Department of Pediatric RheumatologyMofid Children's HospitalShahid Beheshti University of Medical SciencesTehranIran
| | - Mohsen Jari
- Department of PediatricsImam Hossein Children's HospitalIsfahan University of Medical SciencesIsfahanIran
| | - Khosro Rahmani
- Department of Pediatric RheumatologyMofid Children's HospitalShahid Beheshti University of Medical SciencesTehranIran
| | - Roxana Azma
- Department of RadiologyMofid Children's HospitalShahid Beheshti University of Medical SciencesTehranIran
| | - Reza Shiari
- Department of Pediatric RheumatologyMofid Children's HospitalShahid Beheshti University of Medical SciencesTehranIran
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Asano T, Sato S, Temmoku J, Fujita Y, Furuya MY, Matsuoka N, Kobayashi H, Suzuki E, Watanabe H, Migita K. Effectiveness of Tocilizumab in juvenile patients with refractory Takayasu arteritis: Two case reports. Medicine (Baltimore) 2020; 99:e18890. [PMID: 31977898 PMCID: PMC7004659 DOI: 10.1097/md.0000000000018890] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
RATIONALE Takayasu arteritis (TA) is a systemic large-vessel vasculitis which can be accompanied by the symptoms associated with vascular stenosis. PATIENT CONCERNS We describe 2 female juveniles with TA who presented with progressive intermittent claudication. DIAGNOSIS Contrast-enhanced computed tomography (CT) revealed the stenosis of femoral arteries and increased levels of C-reactive protein (CRP), and serum amyloid A (SAA) were noted in both patients. According to European league against rheumatism consensus criteria for the diagnosis of TA was confirmed in both patients. INTERVENTIONS Both patients had shown resistance to glucocorticoids and treated with tocilizumab (TCZ) (subcutaneous injections, 162 mg/week). OUTCOMES These treatments improved claudication symptoms. Follow-up imaging by enhanced CT revealed restoration of advanced stenosis of the femoral arteries in both patients. They achieved normalization of levels of the acute-phase reactants CRP and SAA. Serum levels of interleukin-6 were increased transiently after TCZ injection, but declined to within normal ranges at 12 weeks. LESSONS Juvenile patients with TA presenting with advanced stenosis of the femoral arteries are not rare. The clinical courses of our patients suggested the beneficial effects of TCZ against the progressive vascular stenosis observed in refractory TA.
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Affiliation(s)
- Tomoyuki Asano
- Department of Rheumatology, Fukushima Medical University School of Medicine, Hikarigaoka, Fukushima
| | - Shuzo Sato
- Department of Rheumatology, Fukushima Medical University School of Medicine, Hikarigaoka, Fukushima
| | - Jumpei Temmoku
- Department of Rheumatology, Fukushima Medical University School of Medicine, Hikarigaoka, Fukushima
| | - Yuya Fujita
- Department of Rheumatology, Fukushima Medical University School of Medicine, Hikarigaoka, Fukushima
| | - Makiko Yashiro Furuya
- Department of Rheumatology, Fukushima Medical University School of Medicine, Hikarigaoka, Fukushima
| | - Naoki Matsuoka
- Department of Rheumatology, Fukushima Medical University School of Medicine, Hikarigaoka, Fukushima
| | - Hiroko Kobayashi
- Department of Rheumatology, Fukushima Medical University School of Medicine, Hikarigaoka, Fukushima
| | - Eiji Suzuki
- Department of Rheumatology, Ohta Nishinouchi General Hospital, Koriyama, Fukushima, Japan
| | - Hiroshi Watanabe
- Department of Rheumatology, Fukushima Medical University School of Medicine, Hikarigaoka, Fukushima
| | - Kiyoshi Migita
- Department of Rheumatology, Fukushima Medical University School of Medicine, Hikarigaoka, Fukushima
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Breslauer CA, Evans M, Aurelius MB. Takayasu Arteritis in a 19-Year-Old Black Male: Case Report and Review of the Literature. Acad Forensic Pathol 2019; 9:107-117. [PMID: 34394796 DOI: 10.1177/1925362119851116] [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: 10/09/2018] [Accepted: 11/16/2018] [Indexed: 11/17/2022]
Abstract
Takayasu arteritis (TA) is a rare idiopathic vasculitis of large blood vessels. Prevalence is highest in Japan, with predominance in young females. Classic signs and symptoms include limb claudication, decreased/absent distal pulses, vascular bruits, and blood pressure discrepancy between arms. Without treatment, progression leads to mural fibrosis, stenosis, hypertension, thrombus formation, and ischemic changes of surrounding tissue. Takayasu arteritis is usually a clinical and radiographic diagnosis and has a low mortality rate with effective treatment. Here, we present an unexpected case of TA in a 19-year-old black male diagnosed at autopsy. No suggestion of vasculitis was noted during antemortem workup. Takayasu arteritis may be encountered in the forensic setting in cases of sudden death in a young person, especially in the context of an atypical demographic.
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Sun Y, Kong X, Wu S, Ma L, Yan Y, Lv P, Jiang L. YKL-40 as a new biomarker of disease activity in Takayasu arteritis. Int J Cardiol 2019; 293:231-237. [PMID: 31303395 DOI: 10.1016/j.ijcard.2019.06.058] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/26/2019] [Revised: 06/03/2019] [Accepted: 06/21/2019] [Indexed: 12/21/2022]
Abstract
OBJECTIVE To evaluate the role of YKL-40 as a biomarker of disease activity in patients with Takayasu arteritis (TA). METHODS The study included 40 patients diagnosed with TA between January 2017 and January 2018. 40 age and sex matched healthy controls were included. Serum levels of YKL-40, as well as IL-6, IL-8, IL-17, sCD163, VEGF, MMP-2, MMP-9, OPN, PTX-3 and IFN-γ, were detected at the base line and end of the 6-month follow-up. Modified Kerr criteria, in which MRA was performed instead of traditional angiography, was used a standard measure of disease activity. The association of the measured biomarkers with disease activity was analysed. RESULTS The serum levels of YKL-40, IL-6, IL-8, IFN-γ, MMP-2, MMP-9, PTX-3 and OPN were significantly higher in active disease than in inactive disease. Significant differences in the serum levels of YKL-40, IL-6 and PTX-3 were also observed according to the disease activity degree. Logistic analysis demonstrated that high YKL-40 levels and high IL-6 levels were independent risk factors for active disease. When YKL-40 was combined with IL-6, the specificity and sensitivity for detecting active disease were increased (87.6% and 70.4% respectively); similar findings were obtained when YKL-40 was combined with CRP (72.3% and 84.6% respectively). A predictive model of active disease using ESR, CRP, IL-6, PTX-3 and MMP-9 showed significantly improved diagnostic efficiency when YKL-40 was added to the model (sensitivity: 85.1%; specificity: 94.3%; NRI value: 12.4%; IDI value: 4.6%, p < 0.05). CONCLUSIONS Serum YKL-40 concentrations may be a useful biomarker of disease activity in TA.
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Affiliation(s)
- Ying Sun
- Department of Rheumatology, Zhongshan Hospital, Fudan University, Shanghai, PR China
| | - Xiufang Kong
- Department of Rheumatology, Zhongshan Hospital, Fudan University, Shanghai, PR China
| | - Sifan Wu
- Department of Rheumatology, Zhongshan Hospital, Fudan University, Shanghai, PR China
| | - Lili Ma
- Department of Rheumatology, Zhongshan Hospital, Fudan University, Shanghai, PR China
| | - Yan Yan
- Department of Rheumatology, Zhongshan Hospital, Fudan University, Shanghai, PR China
| | - Peng Lv
- Department of Radiology, Zhongshan Hospital, Fudan University, Shanghai, PR China
| | - Lindi Jiang
- Department of Rheumatology, Zhongshan Hospital, Fudan University, Shanghai, PR China.
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Chen B, Wang X, Yin W, Gao Y, Hou Z, An Y, Li Z, Ren X, Zhao S, Das P, Lu B. Assessment of disease activity in Takayasu arteritis: A quantitative study with computed tomography angiography. Int J Cardiol 2019; 289:144-149. [PMID: 31079971 DOI: 10.1016/j.ijcard.2019.04.086] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/11/2019] [Revised: 04/15/2019] [Accepted: 04/28/2019] [Indexed: 12/18/2022]
Abstract
BACKGROUND Identifying disease activity in Takayasu arteritis (TAK) is challenging. This study aimed to investigate the value of quantitative characterization with computed tomography angiography in the assessment of disease activity in patients with TAK. METHODS We retrospectively analysed the data on 162 aortic CT angiography from 140 TAK patients. Patients were categorized based on disease activity according to the National Institutes of Health criteria into two groups: active disease group (n = 65) and inactive disease group (n = 97). RESULTS Patients with active TAK had a thicker wall compared with patients with inactive TAK (5.2 ± 2.4 mm vs. 2.5 ± 0.8 mm, p < 0.001). The relative post-contrast enhancement ratio of the thickened wall was higher in active TAK than in inactive TAK (1.5 ± 0.3 vs. 1.1 ± 0.2, p < 0.001). Given a thickness cutoff of 3.3 mm, sensitivity for active-phase TAK was 83.1%, specificity 89.7%, positive predictive value 84.4%, and negative predictive value 88.8%. With a relative post-contrast enhancement ratio cutoff of 1.2, sensitivity for active-phase TAK was 89.2%, specificity 76.3%, positive predictive value 71.6%, and negative predictive value 91.3%. In receiver-operating characteristic curves comparison, maximal wall thickness and relative post-contrast enhancement ratio were superior to C-reactive protein and erythrocyte sedimentation rate for determining active phase disease (p < 0.05). CONCLUSIONS Quantitative characterization with CT angiography was a useful tool to assess disease activity in TAK patients. Maximal wall thickness and relative post-contrast enhancement ratio have a high sensitivity and specificity for detecting TAK activity.
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Affiliation(s)
- Baojin Chen
- Department of Radiology, Shandong Provincial Hospital, Key Laboratory of Diagnosis and Treatment of Cardio-cerebral Vascular Diseases, Shandong University, #324, Jingwu Road, Jinan, Shandong 250021, PR China; Department of Radiology, Fuwai Hospital, State Key Laboratory of Cardiovascular Disease, National Centre for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, #167 Bei-Li-Shi Street, Xi-Cheng District, Beijing 100037, PR China
| | - Ximing Wang
- Department of Radiology, Shandong Provincial Hospital, Key Laboratory of Diagnosis and Treatment of Cardio-cerebral Vascular Diseases, Shandong University, #324, Jingwu Road, Jinan, Shandong 250021, PR China.
| | - Weihua Yin
- Department of Radiology, Fuwai Hospital, State Key Laboratory of Cardiovascular Disease, National Centre for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, #167 Bei-Li-Shi Street, Xi-Cheng District, Beijing 100037, PR China
| | - Yang Gao
- Department of Radiology, Fuwai Hospital, State Key Laboratory of Cardiovascular Disease, National Centre for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, #167 Bei-Li-Shi Street, Xi-Cheng District, Beijing 100037, PR China
| | - Zhihui Hou
- Department of Radiology, Fuwai Hospital, State Key Laboratory of Cardiovascular Disease, National Centre for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, #167 Bei-Li-Shi Street, Xi-Cheng District, Beijing 100037, PR China
| | - Yunqiang An
- Department of Radiology, Fuwai Hospital, State Key Laboratory of Cardiovascular Disease, National Centre for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, #167 Bei-Li-Shi Street, Xi-Cheng District, Beijing 100037, PR China
| | - Zhennan Li
- Department of Radiology, Fuwai Hospital, State Key Laboratory of Cardiovascular Disease, National Centre for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, #167 Bei-Li-Shi Street, Xi-Cheng District, Beijing 100037, PR China
| | - Xinshuang Ren
- Department of Radiology, Fuwai Hospital, State Key Laboratory of Cardiovascular Disease, National Centre for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, #167 Bei-Li-Shi Street, Xi-Cheng District, Beijing 100037, PR China
| | - Shuo Zhao
- Department of Radiology, Shandong Provincial Hospital, Key Laboratory of Diagnosis and Treatment of Cardio-cerebral Vascular Diseases, Shandong University, #324, Jingwu Road, Jinan, Shandong 250021, PR China
| | - Pritam Das
- Department of Radiology, Shandong Provincial Hospital, Key Laboratory of Diagnosis and Treatment of Cardio-cerebral Vascular Diseases, Shandong University, #324, Jingwu Road, Jinan, Shandong 250021, PR China
| | - Bin Lu
- Department of Radiology, Fuwai Hospital, State Key Laboratory of Cardiovascular Disease, National Centre for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, #167 Bei-Li-Shi Street, Xi-Cheng District, Beijing 100037, PR China.
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Imamura R, Hayashi K, Sada KE, Yamamura Y, Yamaguchi S, Morishita M, Watanabe H, Matsumoto Y, Wada J. Hemoptysis Originating from the Bronchial Artery in Takayasu Arteritis with Ulcerative Colitis. Intern Med 2019; 58:293-295. [PMID: 30146600 PMCID: PMC6378154 DOI: 10.2169/internalmedicine.1463-18] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
Takayasu arteritis (TAK) is a large-vessel vasculitis affecting the aorta and its main branches. Hemoptysis can be experienced as the respiratory manifestation, but origination from a bronchial artery is rare. Ulcerative colitis (UC) shares genetic similarities with TAK; HLA-B52*01 is associated with TAK and UC. We herein report a patient who presented with hemoptysis from the right bronchial artery and was diagnosed with TAK during the follow-up of UC. Transcatheter embolization was performed, and prednisolone and tocilizumab induced remission. Complication of TAK should be considered in the clinical course of HLA-B52-positive UC patients, and tocilizumab may be a treatment option.
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Affiliation(s)
| | - Keigo Hayashi
- Department of Nephrology, Rheumatology, Endocrinology and Metabolism, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Japan
| | - Ken-Ei Sada
- Department of Nephrology, Rheumatology, Endocrinology and Metabolism, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Japan
| | - Yuriko Yamamura
- Department of Nephrology, Rheumatology, Endocrinology and Metabolism, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Japan
| | - Satoshi Yamaguchi
- Department of Nephrology, Rheumatology, Endocrinology and Metabolism, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Japan
| | - Michiko Morishita
- Department of Nephrology, Rheumatology, Endocrinology and Metabolism, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Japan
| | - Haruki Watanabe
- Department of Nephrology, Rheumatology, Endocrinology and Metabolism, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Japan
| | - Yoshinori Matsumoto
- Department of Nephrology, Rheumatology, Endocrinology and Metabolism, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Japan
| | - Jun Wada
- Department of Nephrology, Rheumatology, Endocrinology and Metabolism, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Japan
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Lim RW, Keh YS, Yeo KK, Khanna NN. Takayasu’s arteritis: a review of the literature and the role of endovascular treatment. ASIAINTERVENTION 2018; 4:117-125. [PMID: 36484003 PMCID: PMC9706770 DOI: 10.4244/aij-d-16-00013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/12/2016] [Accepted: 04/23/2018] [Indexed: 06/17/2023]
Abstract
Takayasu's arteritis (TA) is a chronic non-specific vasculitis with variable presentation in different ethnicities and countries. Treatment options vary and are dependent on the stage and presentation of the disease. We aimed to review current literature related to TA, focusing on the role of endovascular treatment in revascularisation. The temporal course of the disease and stage at presentation influence the management of TA. Treatment options include medical therapy, endovascular intervention or surgical vascular reconstruction. The decision to intervene is individualised according to vascular anatomy and the presence of haemodynamically significant lesions. There are currently no clear guidelines regarding the choice between the endovascular and open surgical approaches, but studies have shown that endovascular procedures are associated with slightly higher rates of restenosis while surgical procedures have higher rates of thrombosis. Periprocedural immunosuppression is suggested if the disease is active at the point of intervention. This improves outcomes but at the cost of immunosuppression-related side effects. Careful long-term follow-up is essential due to the risk of disease activation or flare-up, requiring appropriate evaluation of the diseased vessels.
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Affiliation(s)
| | | | - Khung Keong Yeo
- National Heart Centre Singapore, Singapore
- Duke-NUS Medical School, Singapore
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22
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Liu M, Liu W, Li H, Shu X, Tao X, Zhai Z. Evaluation of takayasu arteritis with delayed contrast-enhanced MR imaging by a free-breathing 3D IR turbo FLASH. Medicine (Baltimore) 2017; 96:e9284. [PMID: 29390488 PMCID: PMC5758190 DOI: 10.1097/md.0000000000009284] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
The primary aim of our case-control study was to observe delayed contrast-enhanced magnetic resonance imaging (DCE-MRI) in patients with Takayasu arteritis (TA) in comparison with magnetic resonance angiography (MRA). Twenty-seven patients including 15 with active TA and 12 with stable TA who underwent both aortic MRA and DCE-MRI were included. A total of 27 sex- and age-matched healthy volunteers were enrolled as the control group. MRA were obtained with T1WI-volume-interpolated breath-hold examination sequence or fast low-angle shot (FLASH) sequence. DCE-MRI was acquired with a free-breathing three-dimensional inversion recovery Turbo fast low-angle shot (3D IR Turbo FLASH). Neither stenosis nor delayed enhancement of arterial wall was shown in the control group. In patients with stable TA, arterial stenosis was observed on MRA. On DCE-MR, delayed enhancement of arterial walls could be observed in the active TA group but not in the stable TA group or the control group. Stenotic arteries on MRA were comparable in the active TA and stable TA (χ = 2.70, P = .259); however, delayed enhancement of arterial walls in the active-TA group were more than those in the stable group (χ = 27.00, P < .001). Our results suggest that DCE-MRI with the free-breathing 3D IR Turbo FLASH sequence could assess TA and delayed enhancement on DCE-MRI is one characteristics of the active TA.
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Affiliation(s)
| | | | | | | | - Xincao Tao
- Department of Pulmonary and Critical Care Medicine, China-Japan Friendship Hospital, Beijing, China
| | - Zhenguo Zhai
- Department of Pulmonary and Critical Care Medicine, China-Japan Friendship Hospital, Beijing, China
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Gülcü A, Gezer NS, Akar S, Akkoç N, Önen F, Göktay AY. Long-Term Follow-Up of Endovascular Repair in the Management of Arterial Stenosis Caused by Takayasu's Arteritis. Ann Vasc Surg 2017; 42:93-100. [DOI: 10.1016/j.avsg.2016.10.066] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2016] [Revised: 09/10/2016] [Accepted: 10/22/2016] [Indexed: 11/24/2022]
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Zhang X, Xu Y, Chen X, Wang S, Li X, Yan X. Treatment of severe hypertension in a 14-year-old child: Successful blood pressure control with additive administration of captopril, an angiotensin-converting enzyme inhibitor, in a patient with bilateral renovascular hypertension. Clin Exp Hypertens 2017. [PMID: 28621587 DOI: 10.1080/10641963.2017.1299747] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
We report a 14-year-old boy with recurrent episodes of headache caused by uncontrolled hypertension. The diagnosis of renovascular hypertension due to Takaysu arteritis (TA) was made based on an increase in erythrocyte sedimentation rate (ESR) and C-reactive protein (CRP) and computed tomography (CT) image of bilateral renal artery stenosis was taken. Renal scintigraphy revealed normal perfusion and function of the right kidney and severe reduction of the perfusion and function of the left kidney. Careful drug adjustments significantly improved but did not fully control the blood pressure (BP); further, angioplasty, which showed almost occlusion of the left renal artery opening and the minor narrowing of the right renal artery, failed to regain sufficient BP control. The addition of captopril, an angiotensin-converting enzyme (ACE) inhibitor, to conventional antihypertensive drugs successfully and safely lowered BP and preserved the renal function. This unique case suggested that ACE inhibitors achieved better control of BP in a patient with bilateral renal stenosis and that the patient may have hemodynamically significant stenosis caused by unilateral renal artery.
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Affiliation(s)
- Xin Zhang
- a Department of Cardiology , West China Hospital, Sichuan University , Chengdu , China
| | - Ying Xu
- a Department of Cardiology , West China Hospital, Sichuan University , Chengdu , China
| | - Xiaoping Chen
- a Department of Cardiology , West China Hospital, Sichuan University , Chengdu , China
| | - Si Wang
- a Department of Cardiology , West China Hospital, Sichuan University , Chengdu , China
| | - Xinran Li
- a Department of Cardiology , West China Hospital, Sichuan University , Chengdu , China
| | - Xin Yan
- a Department of Cardiology , West China Hospital, Sichuan University , Chengdu , China
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Bier G, Kurucay M, Henes J, Xenitidis T, Preibsch H, Nikolaou K, Horger M. Monitoring Disease Activity in Patients with Aortitis and Chronic Periaortitis Undergoing Immunosuppressive Therapy by Perfusion CT. Acad Radiol 2017; 24:470-477. [PMID: 27955964 DOI: 10.1016/j.acra.2016.10.013] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2016] [Revised: 10/26/2016] [Accepted: 10/30/2016] [Indexed: 11/28/2022]
Abstract
RATIONALE AND OBJECTIVES To evaluate the role of perfusion CT for monitoring inflammatory activity in patients with aortitis and chronic periaortitis undergoing immunosuppressive therapy. MATERIALS AND METHODS Seventeen symptomatic patients (median age 68.5 years) who underwent perfusion-based computed tomography (CT) monitoring after diagnostic contrast-enhanced CT were retrospectively included in this study. Blood flow (BF), blood volume (BV), volume transfer constant (k-trans), time to peak, and mean transit time were determined by setting circular regions of interest in prominently thickened parts of the vessel wall or perfused surrounding tissue at sites where the perfusion CT color maps showed a maximum BF value. Differences in CT perfusion and, morphological parameters, C-reactive protein (CRP), and erythrocyte sedimentation rate (ESR) were tested for significance during therapy. RESULTS In all patients BF and BV dropped at second perfusion CT (P < 0.05). In aortitis patients, CRP dropped from 3.86 ± 5.31 mg/dL to 0.9 ± 1.37 mg/dL and in periaortitis patients from 1.78 ± 2.25 mg/dL to 0.79 ± 1.55 mg/dL, whereas ESR dropped from 45.71 ± 37.59 seconds to 8.57 ± 3.1 seconds and 36.78 ± 34.67 seconds to 17.22 ± 21.82 seconds in aortitis and in periaortitis, respectively. CONCLUSIONS The course of perfusion CT parameters in aortitis and chronic periaortitis undergoing immunosuppressive therapy dropped at different extent after therapy.
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Affiliation(s)
- Georg Bier
- Department of Neuroradiology, Eberhard Karls University Tübingen, Hoppe-Seyler-Str. 3, Tübingen 72076, Germany.
| | - Mustafa Kurucay
- Department of Diagnostic and Interventional Radiology, Eberhard Karls University Tübingen, Tübingen, Germany
| | - Jörg Henes
- Department of Internal Medicine-Oncology, Eberhard Karls University Tübingen, Tübingen, Germany
| | - Theodoros Xenitidis
- Department of Internal Medicine-Oncology, Eberhard Karls University Tübingen, Tübingen, Germany
| | - Heike Preibsch
- Department of Diagnostic and Interventional Radiology, Eberhard Karls University Tübingen, Tübingen, Germany
| | - Konstantin Nikolaou
- Department of Diagnostic and Interventional Radiology, Eberhard Karls University Tübingen, Tübingen, Germany
| | - Marius Horger
- Department of Diagnostic and Interventional Radiology, Eberhard Karls University Tübingen, Tübingen, Germany
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Ramponi F, Jeremy RW, Wilson MK. Management of aortic regurgitation and bilateral carotid occlusion in severe Takayasu arteritis. J Card Surg 2017; 32:259-261. [PMID: 28271560 DOI: 10.1111/jocs.13118] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
We present a patient with Takayasu arteritis and severe aortic valve regurgitation and bilateral carotid artery occlusions, who underwent aortic valve replacement and aorto-bicarotid bypass. The management of the cardiovascular manifestations of Takayasu arteritis is reviewed.
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Affiliation(s)
- Fabio Ramponi
- Department of Cardiothoracic Surgery, Royal Prince Alfred Hospital, Sydney, Australia
| | - Richmond W Jeremy
- Department of Cardiology, Royal Prince Alfred Hospital, Sydney, Australia
| | - Michael K Wilson
- Department of Cardiothoracic Surgery, Royal Prince Alfred Hospital, Sydney, Australia
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Jiang W, Yang Y, Lv X, Li Y, Ma Z, Li J. Echocardiographic characteristics of pulmonary artery involvement in Takayasu arteritis. Echocardiography 2017; 34:340-347. [PMID: 28139021 PMCID: PMC5347968 DOI: 10.1111/echo.13464] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
Abstract
BACKGROUND Up to 50% patients with Takayasu arteritis have pulmonary artery involvement. Hence, the early identification of pulmonary artery involvement to facilitate prompt treatment is required. METHODS This retrospective study was performed in patients diagnosed with Takayasu arteritis between January 2009 and January 2016. Pulmonary artery involvement was confirmed with computed tomographic pulmonary angiography. Images from transthoracic echocardiography in three windows (suprasternal right pulmonary artery long-axis view, parasternal aortic short-axis view, and subxiphoid view) were documented and analyzed. RESULTS A total of 27 patients had Takayasu arteritis and pulmonary artery involvement. Characteristic changes identified by echocardiography included luminal medium-to-high echogenic signals, stenosis, and occlusion, as well as intimal thickening. Left pulmonary artery involvement was revealed in the parasternal aortic short-axis view. Right pulmonary artery involvement was best observed in the suprasternal right pulmonary artery long-axis view, with complementary views from the parasternal aortic short-axis and subxiphoid angles. Pulmonary trunk involvement was not observed in all three windows. CONCLUSIONS Transthoracic echocardiography could be a useful noninvasive test to detect pulmonary artery involvement in patients with Takayasu arteritis.
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Affiliation(s)
- Wei Jiang
- Department of Echocardiography, Heart Center, Capital Medical University, Chaoyang Hospital, Beijing, China
| | - Yuanhua Yang
- Department of Respiratory and Critical Care Medicine, Capital Medical University, Chaoyang Hospital, Beijing, China
| | - Xiuzhang Lv
- Department of Echocardiography, Heart Center, Capital Medical University, Chaoyang Hospital, Beijing, China
| | - Yidan Li
- Department of Echocardiography, Heart Center, Capital Medical University, Chaoyang Hospital, Beijing, China
| | - Zhanhong Ma
- Department of Radiology, Capital Medical University, Chaoyang Hospital, Beijing, China
| | - Jifeng Li
- Department of Respiratory and Critical Care Medicine, Capital Medical University, Chaoyang Hospital, Beijing, China
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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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Peracha J, Morgan MD. Urological manifestations and treatment of the primary systemic vasculitides. World J Clin Urol 2015; 4:5-20. [DOI: 10.5410/wjcu.v4.i1.5] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/28/2014] [Revised: 11/17/2014] [Accepted: 12/31/2014] [Indexed: 02/06/2023] Open
Abstract
The primary systemic vasculitides (PSV) are a group of rare inflammatory disorders affecting blood vessels of varying size and multiple organs. Urological manifestations of PSV are uncommon. Testicular vasculitis is the most commonly reported finding and is associated with Polyarteritis Nodosa (PAN), Henoch-Schönlein Purpura (HSP), anti-neutrophil cytoplasm antibody associated Vasculitides (AAV), Giant Cell Arteritis (GCA) and Kawasaki disease. Prostatic vasculitis has been reported in association with GCA and AAV. Ureteric involvement has been noted in PAN, HSP and AAV. Other urogenital manifestations of PSV include genital ulceration and bladder dysfunction in Behçets Disease and haematuria which is commonly seen in many of the PSV. Finally, therapies used to treat the PSV, especially cyclophosphamide, are associated with urological side-effects including haemorrhagic cystitis and urothelial malignancy. The aim of this review is to examine how the urological system is involved in the PSV. Each PSV is examined in turn, with a brief clinical description of the disease followed by a description of the urological manifestations and management. Identification of urological manifestations of PSV is important as in many cases symptoms may improve with immunosuppressive therapy, avoiding the need for invasive surgery. Additionally, patients who present with isolated urogenital PSV are at higher risk of developing subsequent systemic vasculitis and will need to be followed up closely.
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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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De Caridi G, Butrico L, Grande R, Massara M, Spinelli F, de Franciscis S, Serra R. Concomitant Aortic Leiomyosarcoma and Takayasu Arteritis in a 55-Year-Old Male Patient. Ann Vasc Surg 2014; 28:1931.e13-6. [DOI: 10.1016/j.avsg.2014.06.068] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2014] [Revised: 05/31/2014] [Accepted: 06/11/2014] [Indexed: 12/20/2022]
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Yang L, Zhang H, Jiang X, Zou Y, Qin F, Song L, Guan T, Wu H, Xu L, Liu Y, Zhou X, Bian J, Hui R, Zheng D. Clinical Manifestations and Longterm Outcome for Patients with Takayasu Arteritis in China. J Rheumatol 2014; 41:2439-46. [DOI: 10.3899/jrheum.140664] [Citation(s) in RCA: 67] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Objective.To describe a large cohort of patients with Takayasu arteritis in China.Methods.We retrospectively analyzed 566 patients hospitalized in Fuwai Hospital between 2002 and 2013. Data collected were clinical characteristics, laboratory findings, angiographic features, treatment, and longterm outcome.Results.The female to male ratio was 3.8 to 1, and the mean age of onset was 28.9 ± 12.0 years. The most common inflammatory symptom, initial symptom, and coexisting disease were fever (52, 9.2%), dizziness (214, 37.8%), and hypertension (HTN; 392, 69.3%), respectively. Pulmonary artery, coronary artery involvement, and aortic regurgitation were found in 83 (14.7%), 66 (11.7%), and 181 (36.7%) patients, respectively. Elevation of the erythrocyte sedimentation rate was observed in 131 patients (23.1%). Treatment included drugs, interventional therapy, autologous blood vessel transplant, artificial blood vessel transplant, and aortic valve replacement. During a mean followup of 5.0 ± 0.2 years, 32 patients died, including 1 patient who died suddenly during coronary angiography. HTN, major complications, and a progressive disease course were significant prognostic markers.Conclusion.HTN, rather than fever, is the leading reason for patients with Takayasu arteritis to see a doctor in China. HTN, major complications, and a progressive disease course are statistically significant predictors of survival. Because of cardiovascular events associated with the disease, early diagnosis and treatment are urgent to improve prognosis.
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Recent advances in the medical management of Takayasu arteritis: an update on use of biologic therapies. Curr Opin Rheumatol 2014; 26:7-15. [PMID: 24225487 DOI: 10.1097/bor.0000000000000004] [Citation(s) in RCA: 68] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE OF REVIEW To critically review recent advances in medical management of Takayasu arteritis, with a special focus on the rationale and evidence to support the use of biologic agents in this disease. RECENT FINDINGS Multiple case series and observational studies support the use of anti-tumor necrosis factor (TNF) medications, in particular infliximab, in patients who relapse upon tapering steroids and/or adding nonbiologic immunosuppressive agents. However, these medications must be continued to maintain effect, and often patients require increased doses over time. Tocilizumab and rituximab have been shown to lead to improved disease activity in small numbers of Takayasu's patients, including those refractory to anti-TNF treatment. SUMMARY Anti-TNF agents are recommended for the treatment of Takayasu's patients who are unable to taper prednisone despite treatment with a nonbiologic immunosuppressive medication. Whether these biologic agents should be considered earlier in the treatment algorithm of these complicated patients remains an area of interest. Tocilizumab and rituximab may also be of benefit in refractory patients. Prospective randomized controlled trials are needed to confirm these findings.
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Hartlage GR, Palios J, Barron BJ, Stillman AE, Bossone E, Clements SD, Lerakis S. Multimodality Imaging of Aortitis. JACC Cardiovasc Imaging 2014; 7:605-19. [DOI: 10.1016/j.jcmg.2014.04.002] [Citation(s) in RCA: 66] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/21/2013] [Revised: 03/11/2014] [Accepted: 04/04/2014] [Indexed: 02/08/2023]
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Li S. Analysis of 27 cases of large vascular lesions in 161 cases of Behcet's disease: clinical manifestations and treatment outcome. Clin Rheumatol 2014; 33:671-5. [PMID: 24424838 DOI: 10.1007/s10067-013-2471-4] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2013] [Revised: 11/13/2013] [Accepted: 12/17/2013] [Indexed: 01/30/2023]
Abstract
Very little is known about the features of Behcet's disease (BD) with vascular lesions, especially in Chinese population. This study reports the incidence, pattern, and clinical features of vascular lesions in BD patients in China. A total of 161 patients with BD were screened, and 27 patients with vessel involvement were identified. The clinical and laboratory data of the 27 BD patients with vessel involvements were retrospectively analyzed. Of 161 enrolled patients with BD, 27 had large blood vessel damage (16.77 %), with 24 males and 3 females, indicating clear prevalence in males. The average age of onset was 26.2 years old. Seven patients involved arteries only, 15 had vein damage, and 5 showed damage to both arteries and veins. Although vein lesions were more prevalent, arterial lesions were not rare (44.4 % of the vessel-affected BD patients) and could be life-threatening. All 27 patients received various treatments such as steroids, immunosuppressants, anticoagulants, and surgery, and most responded well as evidenced by resumed blood circulation and complete resolution. In conclusion, this study shows features of vessel that involved BD similar to those reported in literatures. Comprehensive treatments lead to significant improvement in BD patients.
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Affiliation(s)
- Shengguang Li
- Department of Rheumatology, The First Affiliated Hospital of Chinese PLA General Hospital, No. 51, Fucheng Rd, Haidian district, Beijing, 100048, China,
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Keser G, Direskeneli H, Aksu K. Management of Takayasu arteritis: a systematic review. Rheumatology (Oxford) 2013; 53:793-801. [DOI: 10.1093/rheumatology/ket320] [Citation(s) in RCA: 143] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
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Novikov PI, Smitienko IO, Moiseev SV. Tumor necrosis factor alpha inhibitors in patients with Takayasu's arteritis refractory to standard immunosuppressive treatment: cases series and review of the literature. Clin Rheumatol 2013; 32:1827-32. [DOI: 10.1007/s10067-013-2380-6] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2013] [Revised: 08/13/2013] [Accepted: 08/20/2013] [Indexed: 11/28/2022]
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