Chronic Takayasu arteritis with a multifocal intimal defect and an intimal flap in the common carotid artery

Takayasu's arteritis presenting with common carotid artery dissection: A rare case report

Takayasu's arteritis (TA) is a rare, idiopathic, chronic inflammatory disease associated with cell-mediated inflammation and involving predominantly the aorta and its primary branches. TA results in stenosis, occlusion or aneurysmal degeneration of large arteries pathologically. However, the incidence of dissection in arteries is low. As one of the primary causes of aortic dissection-associated ischemic stroke in young adults, only a limited number of TA cases presenting with aortic dissection have been published to date. In the present study, a case of common carotid artery dissection in a young patient with TA, without evident clinical manifestations, is presented. This is a rare clinical phenomenon, but may be a risk factor of acute cerebrovascular events. Clinical examination and satisfactory imaging are crucial for the correct diagnosis and management of patients with TA with dissection in arteries, and great attention is required in order to prevent the occurrence of cerebrovascular ischemia.

Sonographic Characterization of Arterial Dissections in Takayasu Arteritis

OBJECTIVES

Takayasu arteritis is a relatively rare chronic nonspecific form of large-vessel vasculitis in which the involved vessels develop stenoses, occlusions, dilatations or aneurysms, and dissections. Dissections of the arteries in patients with Takayasu arteritis are not well understood. In this study, we explored the sonographic characterization of these rare complications secondary to Takayasu arteritis.

METHODS

We evaluated arterial dissections in 72 patients with a clinical diagnosis of Takayasu arteritis by vascular sonography and transthoracic echocardiography. We analyzed the dissection distribution and morphologic characteristics of the dissected intima/layer and lumen of the involved vessels.

RESULTS

Twelve of 72 patients had arterial dissections, in whom 16 dissected segments were identified. The involved arteries included the carotid, subclavian, vertebral, brachial, celiac, and femoral arteries, aortic arch, and abdominal aorta. The dissection lesions occurred at any age and coexisted with the aforementioned injuries. Evaluation of the dissected intima/layer and the involved lumen by sonography was technically complicated. The morphologic characteristics of the dissected intimae and involved lumens were complex, with most of the dissected intimae/layers having the characteristic "macaroni" sign in the arterial wall. High-frequency and high-resolution sonography, color Doppler flow imaging, and other techniques were useful in elucidating greater lesion details.

CONCLUSIONS

Arterial dissections in Takayasu arteritis can involve any anatomic vessel location and have complex morphologic characteristics. Sonography is the optimal technique for diagnosis and follow-up of patients with Takayasu arteritis and dissections.