Related Experiment Videos
Management of cerebral ischemia due to Takayasu's arteritis
Zhonggao Wang1, Laigen Shen, Jun Yu
1Vascular Institute, General Post & Telecom Hospital, the Eighth Clinical College of Beijing University, Beijing 100032, China. zhonggaowang@yahoo.com
Insights
Takayasu
Area of Science:
- Vascular Surgery
- Neurology
- Rheumatology
Background:
- Takayasu's arteritis can cause severe cerebral ischemia due to cervical artery occlusion.
- Management strategies for this condition are critical for patient outcomes.
Purpose of the Study:
- To explore the surgical and interventional management of cerebral ischemia in Takayasu's arteritis patients.
- To evaluate the efficacy and feasibility of revascularization procedures.
Main Methods:
- Retrospective review of 93 Takayasu's arteritis cases with cerebral ischemia.
- Surgical interventions included ascending aorta to carotid/axillary/subclavian bypass and subclavian to carotid bypass.
- Percutaneous transluminal angioplasty (PTA) and stenting were also employed.
Main Results:
- Significant improvement in 30.3% and fair improvement in 34.9% before discharge.
- Long-term follow-up showed sustained improvement in over 69% of patients.
- Mortality before discharge was 9.0%, decreasing to 2.0% at long-term follow-up.
Conclusions:
- Ascending aorta to carotid bypass is a feasible and recommended option for managing severe cerebral ischemia in Takayasu's arteritis.
- Despite successful revascularization, cerebral re-perfusion syndrome remains a significant challenge.
- Early intervention in stable patients can improve cerebral perfusion and outcomes.
Objective:
To explore the management of cerebral ischemia caused by Takayasu's arteritis.
Methods:
Ninety-three cases treated from June 1984 to September 1999 at the General Post & Telecom Hospital, the Sir Run Run Shaw Hospital, the First Affiliated Hospital of Zhejiang University, the Second Medical College of Beijing University, Beijing An Zhen Hospital, and the Beijing Union Medical College Hospital, including 10 men and 83 women, were reviewed. Of the 93 cases, bypasses from the ascending aorta to the axillary or subclavian artery and from graft to the carotid artery were performed in 47 cases. Subclavian to carotid bypass was performed in six cases. Percutaneous transluminal angioplasty (PTA) was used in five cases and stenting in one.
Results:
Marked improvement was achieved in 30.3%, fair in 34.9%, improvement in 21.2%, unchanged in 4.6%, and death in 9.0% before discharge; 30.6%, 38.8%, 16.3%, 4.1%, and 2.0% respectively during a mean follow-up of 48 months, and recurrence requiring revision in 8.2%.
Conclusion:
Patients with occlusive lesions of all four cervical arteries always have severe cerebral ischemia and their distal runoff is always unvisualised by angiography. However, we found by exploration that the internal carotid artery is patent in all but one patient. Therefore, an ascending aorta to carotid bypass is feasible in most instances, and this can and should be done when the cerebral perfusion is jeopardized at a time when the patient is in a stable or relatively stable condition. Unfortunately, the cerebral re-perfusion syndrome is still a serious and not completely solved problem.