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An Immunohistopathologic Study to Profile the Folate Receptor Beta Macrophage and Vascular Immune Microenvironment in Giant Cell Arteritis
06:35

An Immunohistopathologic Study to Profile the Folate Receptor Beta Macrophage and Vascular Immune Microenvironment in Giant Cell Arteritis

Published on: February 8, 2019

Bilateral vertebral artery occlusion with retrograde basilary flow in three cases of giant cell arteritis

Markus Boettinger1, Markus Robert Boettinger, Schreglmann Sebastian

  • 1University of Regensburg, Neurology, Universitaetsstr 84, Regensburg, 93053, Germany.

BMJ Case Reports
|June 22, 2011
PubMed

Insights

Giant cell arteritis (GCA) can cause rare, life-threatening vertebrobasilar ischaemia. This study highlights three cases of bilateral vertebral artery occlusion, emphasizing the need for early diagnosis and management of GCA-related vascular complications.

Area of Science:

  • Neurology
  • Vascular Medicine
  • Rheumatology

Background:

  • Giant cell arteritis (GCA) is an inflammatory condition that can affect large arteries, including the vertebral arteries.
  • Vertebrobasilar ischaemia is a rare but severe complication of GCA, potentially leading to devastating neurological deficits.
  • Bilateral vertebral artery occlusion presents a unique challenge in managing GCA patients.

Purpose of the Study:

  • To describe the clinical presentation, diagnostic findings, and outcomes of three patients with giant cell arteritis and bilateral vertebral artery occlusion.
  • To investigate the role of neurovascular imaging in identifying vertebrobasilar compromise in GCA.
  • To discuss potential management strategies and prognostic factors for patients with this rare complication.

Main Methods:

  • Case series reporting on three patients diagnosed with GCA and bilateral vertebral artery occlusion.
  • Utilized advanced neurovascular imaging techniques including CT-angiography, MR-angiography, and colour-coded duplex sonography.
  • Monitored patients' clinical status, neurological outcomes, and response to treatment over a 12-month follow-up period.

Main Results:

  • All three patients exhibited inflammation of the vertebral vessel wall and flow reversal in the basilar artery.
  • One patient experienced a fatal massive brainstem infarction.
  • The two surviving patients remained stroke-free at 12 months on warfarin and steroid therapy, despite persistent bilateral vertebral artery occlusion and retrograde basilar artery flow.

Conclusions:

  • Bilateral vertebral artery occlusion in GCA is a high-risk condition associated with significant morbidity and mortality.
  • Effective management likely depends on potent immunosuppression, addressing comorbid atherosclerotic disease, and developing adequate collateral circulation.
  • Identifying patients at risk for vertebrobasilar ischaemia is crucial for selecting adjunctive treatments, such as anticoagulation, in GCA management.

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