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[Bilateral intracerebral angioplasty in a patient with stroke caused by giant cell arteritis]
N Chausson1, S Olindo, A Signaté
1Service de neurologie, CHU de Fort-de-France, La Meynard, 97200 Fort-de-France, Martinique, France. nicolaschausson@hotmail.com
Insights
Giant cell arteritis (GCA) can lead to stroke due to carotid stenosis. Endovascular treatment, like angioplasty and stenting, offers a promising alternative for GCA patients experiencing neurological decline.
Area of Science:
- Neurology
- Vascular Surgery
- Rheumatology
Background:
- Giant cell arteritis (GCA) is the most common vasculitis affecting large arteries.
- GCA frequently causes stroke, often due to hemodynamic compromise from arterial stenosis or occlusion.
- Current treatment strategies for GCA-related stroke have suboptimal outcomes.
Observation:
- A 78-year-old patient with GCA experienced neurological deterioration despite corticotherapy.
- Brain MRI revealed bilateral strokes secondary to multiple preocclusive internal carotid artery stenosis.
- The patient underwent successful angioplasty and stenting for the carotid stenosis.
Findings:
- Endovascular treatment, including angioplasty and stenting, effectively addressed severe carotid stenosis in a GCA patient.
- This intervention led to the resolution of neurological deterioration.
- The case highlights a potential therapeutic option beyond standard medical management.
Implications:
- Endovascular therapy may be a viable alternative for GCA patients with neurological deterioration due to hemodynamic instability or recurrent strokes.
- Standard medical treatment alone may be insufficient for managing GCA-associated cerebrovascular complications.
- This approach could improve outcomes for a subset of GCA patients with severe stenosis.
Introduction:
Giant cell arteritis is the most frequent vasculitis and can cause stroke in about 4% of the patients. The mechanism is often hemodynamic in relation with an arterial stenosis or occlusion. Optimal treatment remains to be defined. Outcome is often poor.
Case Report:
We report the case of a 78-year-old patient, with giant cell arteritis who developed neurological deterioration after the onset of the corticotherapy. Brain MRI revealed bilateral stroke caused by multiple preocclusive internal carotid stenosis. The patient was treated successfully with angioplasty and stenting.
Conclusion:
Endovascular treatment could constitute an interesting alternative for patients with giant cell arteritis associated with neurological deterioration after a first episode of stroke because of hemodynamic instability or at stroke recurrence. For these patients, the usual medical treatment appears to be insufficient.
