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Percutaneous transluminal angioplasty in Takayasu arteritis
1Department of Cardiology, Govind Ballabh Pant Hospital, New Delhi, India.
Insights
Percutaneous transluminal balloon angioplasty (PTBA) effectively treated stenotic lesions in Takayasu arteritis patients. This minimally invasive procedure showed high success rates and sustained relief in aorta and renal arteries, improving blood flow.
Area of Science:
- Cardiovascular Medicine
- Interventional Radiology
- Vascular Surgery
Background:
- Takayasu arteritis is a rare, chronic inflammatory disease affecting large arteries, primarily the aorta and its branches.
- Vascular stenosis in Takayasu arteritis can lead to severe complications, including hypertension and organ ischemia.
- Percutaneous transluminal balloon angioplasty (PTBA) is a potential treatment option for managing arterial stenosis in these patients.
Purpose of the Study:
- To evaluate the efficacy and safety of PTBA in treating stenotic lesions caused by Takayasu arteritis.
- To assess the immediate and long-term outcomes of PTBA in various affected arteries.
Main Methods:
- Retrospective analysis of 87 patients with 111 stenotic lesions due to Takayasu arteritis.
- PTBA performed on aorta, renal, subclavian, and common iliac arteries.
- Hemodynamic and angiographic follow-up studies to assess restenosis and long-term patency.
Main Results:
- Successful dilatation achieved in 94.3% of aortic lesions and 90.6% of renal artery lesions.
- Significant reduction in pressure gradients and increase in luminal diameter post-PTBA.
- Long-term follow-up demonstrated sustained relief of stenosis in most cases, with manageable restenosis rates.
Conclusions:
- PTBA is a safe and effective treatment for arterial stenosis in Takayasu arteritis.
- The procedure leads to significant hemodynamic improvement and maintains patency in the majority of treated lesions.
- PTBA offers a valuable therapeutic option for patients with Takayasu arteritis-related vascular complications.
Abstract:
Percutaneous transluminal balloon angioplasty (PTBA) was performed in 87 patients for 111 stenotic lesions due to Takayasu arteritis. Of the lesions attempted for dilatation, 35 were in the aorta, 64 in renal arteries, 9 in subclavian, and 3 in common iliac arteries. The stenosis of aorta could be successfully dilated in 33 of 35 (94.3%) patients with fall in peak systolic pressure gradient (PSG) from 77.7 +/- 28.4 mmHg to 26.4 +/- 20.6 mmHg (P < 0.001) and increase in luminal diameter from 4.7 +/- 2.4 mm to 10.1 +/- 4.1 mm (P < 0.001). On hemodynamic and angiographic restudy in 20 patients at 3-24 months (mean 7.7 +/- 4.1 months) further fall in PSG (> or = 15 mmHg) was observed in 7 patients, no significant change in 12 patients and restenosis with increase in PSG in one patient which could be successfully redilated. Late restudy at 36-60 months (mean 43 +/- 9.4) in six patients showed continued relief of stenosis (mean PSG 8.8 +/- 7.8 mmHg). Of the 64 stenotic lesions of the renal arteries, 58 (90.6%) could be successfully dilated with decrease in stenosis from 89.1 +/- 10.1% to 29.9 +/- 14.9% (P < 0.001). Follow-up intra-arterial digital subtraction angiography in 25 patients at a mean follow-up period of 13.1 months (range 3-29 months) showed restenosis in 5/36 (13.9%) lesions which could be successfully redilated. Angioplasty was also successful in dilating 8/9 (88.9%) subclavian and all 3 common iliac artery stenosis.(ABSTRACT TRUNCATED AT 250 WORDS)