Single Stage Multiple Stenting in Takayasu's Arteritis (original) (raw)
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Efficacy and Safety of Primary Stenting in Takayasu Arteritis: Report of Four Cases
The Internet Journal of Cardiology, 2009
Background-Takayasu arteritis (TA), an inflammatory disease of unknown origin, frequently affects major aortic branch vessels and causes many symptoms, including brain and retinal ischemia and hypertension. Methods-Four patients with Takayasu arteritis (TA) underwent angioplasty and stent placement in the renal arteries due to uncontrolled hypertension. Complications of the procedure include transient bradycardia and mild hypotension, probably due to contrast agent; however, there was no major complication. Results-No restenosis has been reported in the six-month follow up of the patients with angiography. Serum creatinine levels remained unchanged in the four patients. The difference between pre-and post-interventional arterial blood pressures was measured. Mean systolic blood pressure changed from 227.5 mmHg to 150mmHg and mean diastolic pressure dropped from 122mmHg to 85 mmHg. Conclusion-The stenotic lesions in TA can be managed successfully with angioplasty and stent placement. Short-term follow up showed stenting had increased the success rate of the procedure, achieved larger luminal diameters and it seemed to decrease the incidence of restenosis. However long-term follow up is suggested to determine the restenosis rate.
European Journal of Radiology, 1999
A 32-year old woman was admitted to the hospital with a sudden onset of right-sided hemiplegia and aphasia. Immediate angiographic examination revealed a severe form of type I Takayasu arteritis with occlusion of all supra-aortic vessels, with the exception of the left subclavian artery which was, however, almost completely occluded 1 cm proximal to the origin of the left vertebral artery. Since the latter provided the entire blood supply to the brain tissues, an immediate attempt was undertaken to dilate the left subclavian artery; when this was unrewarding, stenting of the lesion was successfully accomplished with excellent primary and 6-month follow-up results.
Journal of Vascular and Interventional Radiology, 2008
PURPOSE: Takayasu arteritis (TA) is a rare form of inflammatory arteriopathy affecting the aorta and its major branches. Obstructive lesions of all arch vessels may lead to disabling neurologic symptoms. There is limited experience with endovascular revascularization in this situation. The present report describes immediate and follow-up results with stent-supported angioplasty of severely stenosed single patent arch arteries.
A Case Report of Takayasu’s Arteritis With Cerebral Infarction As Initial Presentation
Cureus
Takayasu's arteritis is a chronic inflammation of the large arteries such as the aorta and its primary branches, causing progressive arterial occlusion. This leads to reduced blood flow in the limbs and organs, resulting in arm or leg claudication, diminished or absent peripheral pulses, and end-organ ischemia. Stroke is one of the common complications; however, it is rarely the initial presentation. We describe one such case of a 16-year-old female, who presented with right-sided hemiparesis and non-fluent aphasia, without any significant past history. On examination, her right arm was cold and pulseless. She was extensively investigated for the cause of her presentation. Only non-specific inflammatory markers such as erythrocyte sedimentation rate (ESR) were elevated. Imaging studies revealed left middle cerebral artery territory infarct with occlusion of common carotid arteries, bilateral bifurcation, most parts of the left internal carotid artery, and the proximal part of the right internal carotid artery. She was diagnosed with Takayasu's arteritis and was prescribed steroids, on which she gradually recovered and was discharged. In conclusion, young patients, who present with stroke, should be investigated for Takayasu's arteritis, which leads to earlier treatment and prevention of further life-threatening end-organ damage.
Texas Heart Institute journal / from the Texas Heart Institute of St. Luke's Episcopal Hospital, Texas Children's Hospital, 2006
We describe the case of a young woman with Takayasu's arteritis that initially manifested as heart failure due to left main coronary artery stenosis. The patient's occluded subclavian artery and the active inflammatory process of Takayasu's arteritis precluded coronary artery bypass grafting with the use of arterial grafts. Therefore, a drug-eluting stent was placed in the unprotected left main artery. This procedure resulted in the resolution of symptoms, with a patent stent and no new coronary lesions observed on 3-month angiography, and normal left ventricular function on 9-month echocardiography. We conclude that the use of drug-eluting stents may be an important treatment option for Takayasu's arteritis patients with life-threatening coronary artery disease for whom coronary artery bypass grafting is not an option.
JACC. Cardiovascular interventions, 2014
I n Takayasu arteritis, obliteration of the vessel lumen by mural thrombus secondary to inflammatory changes in the vessel wall is common in the aortic arch branches; the thrombus gradually undergoes organization and becomes a fibrous mass within which multiple vascular channels develop. In some cases, these channels allow partial restoration of anterograde flow through the previously occluded artery segment (1). This phenomenon was seen angiographically in the common carotid arteries of a 43-year-old man who presented with dizziness, amaurosis fugax, and bilateral arm claudication. He met 5 of the 6 American College of Rheumatology criteria for diagnosis of Takayasu arteritis (2) and had normal levels of inflammatory markers indicating inactive disease. Both common carotid arteries exhibited diseased segments containing tangles of corkscrew channels located within the expected confines of the vessel wall (Figures 1A, 1C, and 1E) with limited anterograde flow through them. The subclavian arteries had long-segment occlusions bilaterally, but these were solid occlusions without angiographic evidence of vascular channels within them. After obtaining informed consent, the diseased common carotid artery segments were traversed by fine manipulation of 0.014-inch steerable hydrophilic wires, after which balloon dilation and selfexpanding stent deployment resulted in replacement of the multiple vascular channels by a single large channel with normal anterograde flow (Figures 1B and 1D). Interventions on the 2 sides were performed 6 months apart without cerebral protection and were uncomplicated; the subclavian artery occlusive lesions were concurrently recanalized and stented using standard technique. Follow-up angiography after 2 years (Figure 1F) showed widely patent carotid stents and minor subclavian in-stent restenosis; the patient was asymptomatic over this period. In Takayasu arteritis patients with inactive disease, arterial lesions with angiographic evidence of multiple vascular channels inside the expected limits of the vessel wall with limited anterograde flow are indicative of chronic fibrous, partially recanalized occlusions that are amenable to successful percutaneous intervention.
Contemporary Challenges of Acute Ischemic Stroke in Takayasu Arteritis
Stroke, 2020
A 59-year-old woman presented with 5 hours of right-sided weakness and aphasia. She had a history of Takayasu arteritis (TA), managed for 10 years with oral prednisolone. Her right radial pulse was not palpable, and a bruit was audible over the right subclavian artery. Blood pressure in the right and left upper extremities was 85/69 mm Hg and 119/67 mm Hg. National Institutes of Health Stroke Scale score was 12 at admission, and she had no history of cerebrovascular event. Computed tomography showed hypodensity of the left basal ganglia and caudate head with angiography demonstrating left common carotid artery (CCA) and left middle cerebral artery occlusions as well as large ischemic penumbra (Figure 1). tPA (tissue-type plasminogen activator) was not given because she was referred to care 5 hours after symptom onset. As such, she underwent angiography which confirmed numerous steno-occlusive lesions in the supra-aortic branch vessels (Figure 2A through 2C).
Takayasu’s arteritis (TA) is an inflammatory disease of large vessels that predominantly affects the aorta and its main branches such as supra-aortic trunks, renal and digestive arteries. The diagnosis is based on criteria proposed by the American College of Rheumatology and modifi ed by Sharma. These vascular lesions present a problem of surgical indications because of their pathogenic particularity. In this work, we report our experience on the diagnosis and management of two cases of TA. The case 1 was a 62-year-old female patient diagnosed with stenosis of the common carotid artery and the right subclavian artery. A bypass between the carotid artery and the subclavian artery was indicated but not performed. The second patient was a 23-year-old female patient diagnosed with renovascular hypertension. Investigations showed a significant stenosis of the left renal artery. She underwent angioplasty-stenting of the left renal artery and the result was good. Her echocardiography showed left ventricular and atrial hypertrophy and both. The two patients had no indirect signs of myocardial ischemia and arterial pulmonary injuries