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Clinical and vascular features of stroke in Takayasu's arteritis: A 24-year retrospective study
Guizhi Zhang1, Jun Ni2, Yunjiao Yang1
1Department of Rheumatology, Peking Union Medical College Hospital (PUMCH), Chinese Academy of Medical Sciences, National Clinical Research Center for Dermatologic and Immunologic Diseases (NCRC-DID), Key Laboratory of Rheumatology and Clinical Immunology, Ministry of Education, Chinese Rheumatism Data Center (CRDC), Beijing 100730, China.
Insights
Stroke is a significant initial manifestation in Takayasu
Area of Science:
- Vascular Neurology
- Rheumatology
- Internal Medicine
Background:
- Takayasu's arteritis (TA) is a large vessel vasculitis with potential neurological complications.
- Stroke is a serious manifestation of TA, impacting patient prognosis.
- Understanding the characteristics of TA-associated stroke is crucial for timely diagnosis and management.
Purpose of the Study:
- To investigate the clinical features, vascular imaging findings, and outcomes of Takayasu's arteritis patients who experience stroke.
- To identify specific vascular involvement patterns and inflammatory markers associated with stroke in TA patients.
- To evaluate the prognosis and treatment strategies for TA patients with stroke.
Main Methods:
- Retrospective review of 411 in-patients diagnosed with Takayasu's arteritis (TA) based on 1990 ACR criteria.
- Analysis of demographic data, clinical symptoms, laboratory results, and radiological findings, including cranial angiography.
- Comparison of patients with and without stroke using Chi-square or Fisher exact tests.
Main Results:
- Stroke occurred in 6.3% of TA patients (26/411), often as an initial manifestation (11/26).
- Patients with stroke showed higher rates of visual acuity loss and intracranial vascular involvement (38.5% vs. 5.5%).
- Commonly affected arteries included the common carotid artery, subclavian artery, and internal carotid artery, with the middle cerebral artery most frequently involved intracranially. Stroke patients exhibited less systemic inflammation.
Conclusions:
- Stroke is a frequent initial presentation in Takayasu's arteritis, often linked to increased intracranial vascular involvement.
- Cervical and intracranial arteries are commonly affected in TA patients with stroke, with reduced systemic inflammation observed.
- Aggressive treatment combining glucocorticoids, immunosuppressants, and anti-stroke therapies is recommended to improve outcomes for TA patients with stroke.
Objective:
To investigate the clinical characteristics, vascular imaging features, and prognosis of Takayasu's arteritis (TA) patients with stroke in China.
Methods:
Medical charts of 411 in-patients who fulfilled the classification criteria of modified 1990 American College of Rheumatology (ACR) criteria for TA and with complete data from 1990 to 2014 were reviewed retrospectively. The demographic data, symptoms and signs, laboratory test results, radiological features, treatment, and interventional or surgical procedures were collected and analyzed. Patients with radiological confirmed stroke were identified. Chi-square test or Fisher exact test was used to compare the differences between patients with and without stroke.
Results:
Twenty-two patients with ischemic stroke (IS) and 4 patients with hemorrhagic stroke were identified. The incidence of stroke in TA patients was 6.3% (26/411), of which 11 patients were considered to be the initial manifestation. Stroke patients had more visual acuity loss (15.4% vs. 4.7%, P = 0.042). Systemic inflammatory symptoms and inflammatory markers were less common in patients with stroke than in those without stroke [fever P = 0.007; erythrocyte sedimentation rate (ESR) or C-reactive protein (CRP), P < 0.001]. Cranial angiography showed that common carotid artery (CCA) (73.0%, 19/26) and subclavian artery (SCA) (73.0%, 19/26) were the most involved, followed by internal carotid artery (ICA) (57.7%, 15/26) in stroke patients. The intracranial vascular involvement rate of stroke patients was 38.5% (10/26); the middle cerebral artery (MCA) was the most common artery involved. The most common site of stroke was the basal ganglia region. The occurrence of intracranial vascular involvement was much higher in patients with stroke when compared to patients without stroke (38.5% vs. 5.5%, P < 0.001). Among all patients with intracranial vascular involvement, patients without stroke received more aggressive treatment than patients with stroke (90.4% vs. 20.0%, P < 0.001). There was no significant increase in in-hospital mortality in patients with stroke compared with patients without stroke (3.8% vs. 2.3%, P = 0.629).
Conclusion:
Stroke is the initial presentation in 50% of TA patients with stroke. The intracranial vascular involvement rate is significantly increased in stroke patients than in patients without stroke. The artery invloved in patients with stroke are cervical artery and intracranial involvement. Systemic inflammation is less in patients with stroke. Aggressive treatment for TA with glucosteroid (GC) and immunosuppressive agents combined with anti-stroke therapy is needed to improve the prognosis of TA complicated stroke.
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