Journal of Rare Cardiovascular Diseases

ISSN: 2299-3711 (Print) e-ISSN: 2300-5505 (Online)

Long‑term experience in patients undergoing endovascular revascularization procedures for symptomatic Takayasu arteritis (RCD code: I-3A.1)

Leszek Wrotniak, Anna Kabłak‑Ziembicka, Tadeusz Przewłocki, Piotr Pieniążek, Jakub Podolec, Piotr Musiałek, Krzysztof Żmudka, Piotr Podolec

 

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Abstract

Takayasu arteritis (TA) is often manifested by a prolonged limb claudication, renovascular hypertension or a sudden ischemic stroke (IS) or myocardial infarction (MI) occurring in young adults. The study aimed to assess the long‑term outcome in patients with TA referred to endovascular revascularization procedure (PTA). Methods. The study group comprised 20 patients with TA (19 women, 1 men), at the mean age of 45.3±6.6 (range 30–52) years at the time of the first diagnosis of an arterial stenosis. In 70% of patients significant stenosis or occlusion affected more than one major arterial territory. Significant coronary stenosis was observed in 8(40%) patients. All patients were assessed for the prevalence of cardiovascular risk factors, inflammatory activity (hs‑CRP, white blood count: – WBC) and the incidences of restenosis (RS), cardiovascular death (CVD), MI, IS/TIA or symptomatic lesion progression at follow‑up (SLP). Results. A total of 28 PTAs were performed as a result of the initial evaluation, including 11 subclavian or innominate, 6 carotid, 8 renal,  1 vertebral, 1 coronary and 1 PTA of the abdominal aorta. During the follow‑up period of 98 ±28 months (range 12–165 months), CV events occurred in 3(15%) patients, including 1(5%) CVD, 1(5%) IS, and 1(5%) IM. SLP was observed in 11(55%) patients in 17 previously non obstructed arterial locations. 14 of these lesions required PTA. Significant RS in at least one revascularized artery concerned 11(55%) patients and was observed in case of 13 previously performed PTA’s; 11 of those lesions required re‑PTA. Recurrent RS was noted in 4 patients. Conclusions. In patients with TA, RS and SLP rates are high, thus the follow‑up of these patients is crucial. PTA is a valuable alternative to surgery for patients with TA. JRCD 2013; 1 (5): 8–13

Keywords

Takayasu arteritis; endovascular revascularization; cardiovascular events; restenosis; lesion progression; long‑term

References

Zalewska J, Ignaczak P, Bilińska‑Reszkowska H, et al: Choroba Takayasu. Reumatologia 2009; 47: 376–80 6.

Kerr GS, Hallahan CW, Giordano J, et al. Takayasu arteritis. Ann Intern Med 1994; 120: 919–929.

Qureshi MA, Martin Z, Greenberg RK. Endovascular Management of

Patients with Takayasu Arteritis: Stents versus Stent Grafts. Semin Vasc Surg 2011; 24: 44–52.

Perera AH, Mason JC, Wolfe JH. Takayasu arteritis: criteria for surgical intervention should not be ignored. Int J Vasc Med. Epub 2013 Aug 6. A head of print.

Kim HJ., Lee CS, Kim JS, et al. Outcomes after Endovascular Treatment of Symptomatic Patients with Takayasu’s Arteritis. Interv Neuroradiol 2011; 17: 252–260.

Saadoun D, Lambert M, Mirault T, et al. Retrospective analysis of surgery versus endovascular intervention in Takayasu arteritis a multicenter experience. Circulation 2012; 125: 813–819.

Ham SW, Kumar SR, Wang BR, Rowe VL, Weaver FA. Late outcomes of endovascular and open revascularization for nonatherosclerotic renal artery disease. Arch Surg 2010; 145: 832–839.

Fries JF, Hunder GG, Bloch DA, et al. The American College of Rheumatology 1990 criteria for the classification of vasculitis. Summary. Arthritis Rheum 1990; 33: 1135–1136.

Tendera M, Aboyans V, Bartelink ML, et al on behalf of The Task Force on the Diagnosis and Treatment of Peripheral Artery Diseases of the European Society of Cardiology (ESC). ESC Guidelines on the diagnosis and treatment of peripheral artery diseases. Eur Heart J 2011; 32: 2851–2906.

Perera AH, Mason JC, Wolfe JH. Takayasu arteritis: criteria for surgical intervention should not be ignored. Int J Vasc Med. Epub 2013 Aug 6.

Sharma BK, Iliskovic NS, Singal PK. Takayau’s arteritis may be underdiagnosed in North America. Can J Cardiol 1995; 1: 311–6.

Przewłocki T, Kabłak‑Ziembicka A, Pieniążek P, et al. Czynniki predykcyjne restenozy u chorych uprzednio leczonych angioplastyką z powodu zwężenia tętnicy podobojczykowej. Postępy w Kardiologii Interwencyjnej 2009; 5: 1–6.

Pieniążek P, Musiałek P, Kabłak‑Ziembicka A, et al. Carotid artery stenting with patent and lesion tailored selection of the neuroprotection system and stent type: early and 5‑year results from a prospective academic registry of 535 consecutive procedures (TARGET‑CAS). J Endovasc Therapy 2008;15: 249 – 262.

Przewłocki T, Kabłak‑Ziembicka A, Kozanecki A, et al. Polyvascular extracoronary atherosclerotic disease in patients with coronary artery disease. Kardiol Pol 2009; 67: 978–984.

Maksimowicz‑McKinnon K., Clark T. M., Hoffman G. S. et al. Limitations of Therapy and a Guarded Prognosis in an American Cohort of Takayasu Arteritis Patients. Arthritis & Rheumatism 2007; 56: 1000–1009.

Maffei S, Di Renzo M, Bova G et al. Takayasu’s Arteritis: a review of the literature. Intern Emerg Med;2006;1:105–12 5.

Kerr GS, Hallahan CW, Giordano J et al,tem M, et al. Takayasu arteritis. Ann Int Med 1994;120: 919–29.

Jain S, Kumari S, Ganguly NK, Sharma BK. Current status of Takayasu arteritis in India. Int J Cardiol 1996;54 Suppl:S111–6.

Vanoli M., Daina E.,2 Salvarani C. et al. Takayasu’s Arteritis: A Study of 104 Italian Patients. Arthritis & Rheumatism (Arthritis Care & Research) 2005; 53: 100–107.

Mukhtyar C, Guillevin L, Cid MC, et al., “EULAR recommendations for the management of large vessel vasculitis,” Ann Rheumatic Dis 2009; 68: 318–23.

Hoffman GS, Ahmed AE. Surrogate markers of disease activity in patients with Takayasu arteritis. Int J Cardiol 1998;66(Suppl 1):S191–4.

Sharma B.K., Jain S., Bali H.K. et al. A follow‑up study of balloon angioplasty and de‑novo stenting in Takayasu arteritis International Journal of Cardiology 2000; 75: 147–152.

Kim H.J., Lee C‑S., Kim J.S. et al. Outcomes after Endovascular Treatment of Symptomatic Patients with T akayasu’s Arteritis Interventional Neuroradiology 2011; 17: 252–260.

Sharma S., Gupta A. Visceral artery interventions in takayasu’s arteritis. Seminars in Interventional Radiology 2009; 26: 233–244.

Andrews J, Mason JC. Takayasu’s arteritis—recent advances in imaging offer promise. Rheumatology 2007; 46: 6–15.

Soeiro AM, Almeida MC, Torres TA, et al. Clinical characteristics and long‑term outcome of patients with acute coronary syndromes and Takayasu arteritis. Rev Port Cardiol. 2013; 32: 297–302.

Spacek M, Zimolova P, Veselka J. Takayasu arteritis: use of drug‑eluting stent and balloon to treat recurring carotid restenosis. J Invasive Cardiol. 2012; 24: E190–2.

Numano F. Inflammation and atherosclerosis. Atherosclerotic lesions in Takayasu arteritis. Ann NY Acad Sci 2000; 902: 65–76.

Manzi S, Wasko MC. Inflammation‑mediated rheumatic diseases and atherosclerosis. Ann Rheum Dis 2000; 59: 321–325.

Cohen Tervaert JW. Cardiovascular disease due to accelerated atherosclerosis in systemic vasculitides. Best Pract Res Clin Rheumatol. 2013; 27: 33–44.

Wu W, Chaer RA. Nonarteriosclerotic vascular disease. Surg Clin North Am 201;93:833–75.

DOI: http://dx.doi.org/10.20418%2Fjrcd.vol1no5.130

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