Outcomes of Percutaneous Intervention in Patients With Takayasu Arteritis
George Joseph1, Viji S Thomson1, Thomas V Attumalil1
1Department of Cardiology, Christian Medical College, Vellore, India.
Insights
Percutaneous intervention (PI) effectively treats vascular lesions in Takayasu arteritis (TAK). Stent-based strategies offer safe and durable outcomes for most patients, improving lesion success rates with repeat interventions.
Area of Science:
- Cardiovascular Medicine
- Interventional Cardiology
- Rheumatology
Background:
- The optimal treatment for vascular lesions in Takayasu arteritis (TAK) using percutaneous intervention (PI) requires further clarification.
- TAK is a large-vessel vasculitis often leading to arterial stenosis, occlusion, aneurysms, or dissection.
Purpose of the Study:
- To establish effective percutaneous intervention (PI) strategies tailored for Takayasu arteritis (TAK).
- To evaluate the safety and durability of various PI techniques in treating diverse arterial lesions in TAK patients.
Main Methods:
- Retrospective analysis of a prospectively maintained single-center database of TAK PI procedures (1996-2022).
- Treatment modalities included elective stenting (bare/covered), balloon angioplasty (BA), and cutting-balloon angioplasty (CBA), with repeat PIs for restenosis.
- Management of aneurysms/dissections involved covered stents or endografts, alongside long-term immunosuppressive therapy.
Main Results:
- 942 patients underwent 3,805 PIs for 2,450 lesions; early and late success rates were 92.3% and 84.5%, respectively.
- Repeat PIs significantly improved late success in obstructive lesions (48.6% to 83.3%).
- Covered stents showed lower restenosis rates than bare stents; PI achieved 91.3% late success for aneurysms/dissections.
Conclusions:
- Percutaneous intervention (PI), particularly stent-based strategies, provides effective, safe, and durable treatment for most vascular lesions in Takayasu arteritis (TAK).
- Repeat interventions and the use of covered stents enhance long-term outcomes in TAK patients.
Background:
The status of vascular lesion treatment using percutaneous intervention (PI) in Takayasu arteritis (TAK) remains unresolved.
Objectives:
This study sought to develop PI strategies appropriate for TAK.
Methods:
A prospectively maintained single-center database of TAK PI procedures from 1996 to 2022 was analyzed retrospectively. Obstructive lesions were treated by elective stenting (using bare or covered stents), balloon angioplasty (BA), or cutting-balloon angioplasty (CBA), with adjunctive stenting for suboptimal BA or CBA results. PIs were repeated in restenotic lesions until sustained success was obtained. Aortic or peripheral aneurysms and spontaneous aortic dissections were treated with covered stents or endografts. Immunosuppressive therapy, started before PI, was continued long term.
Results:
A total of 942 patients underwent PI to treat 2,450 arterial lesions (2,365 stenoses or occlusions, 85 aneurysms or dissections) in 630 subclavian or axillary, 586 renal, 463 aortic, 333 carotid, 188 mesenteric, 116 iliac, 71 coronary, and 63 other arteries; 3,805 PIs were performed (1.55 PIs per lesion; range 1-7 PIs per lesion). Early success was obtained in 2,262 (92.3%), and late success in 1,460 (84.5%) of 1,727 lesions with a median of 39 months (IQR: 15-85 months) of follow-up. Repeated PIs increased late success in obstructive lesions from 48.6% to 83.3%. A total of 1,687 elective stenting lesions achieved 88% late success with 1.49 PIs per lesion; covered stents (1.18 PIs per lesion) restenosed less than bare stents (1.51 PIs per lesion; P < 0.001). A total of 183 (36%) of 513 BA-treated lesions had good outcomes without adjunctive stenting; 122 CBA-treated lesions had 19% dissections and 8% ruptures or pseudoaneurysm formations. Aneurysms or dissections had 91.3% late success after PI. A total of 472 complications occurred in 415 (17%) lesions; 375 (79%) were resolved.
Conclusions:
Most vascular lesions in TAK can be effectively, safely, and durably treated using predominantly stent-based PI strategies.
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