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Ultrasonographic study and long-term follow-up of Takayasu's arteritis
Insights
Takayasu's arteritis commonly affects the aorta and its branches, particularly in young women. Duplex ultrasonography reveals characteristic intima-media thickening in carotid arteries, with unpredictable progression, highlighting its value for long-term follow-up.
Area of Science:
- Vascular Medicine
- Rheumatology
- Diagnostic Imaging
Background:
- Takayasu's arteritis is an inflammatory vasculopathy affecting the aorta and its major branches.
- Limited data exists on the natural history and temporal changes in carotid vessels during Takayasu's arteritis.
- Duplex ultrasonography shows promise for characterizing and monitoring brachiocephalic vascular changes.
Purpose of the Study:
- To investigate the natural history and temporal profile of carotid vessel changes in Takayasu's arteritis.
- To evaluate the utility of duplex ultrasonography in assessing brachiocephalic vascular involvement.
- To characterize the specific ultrasonographic findings in Takayasu's arteritis.
Main Methods:
- Studied 16 female patients meeting Takayasu's arteritis diagnostic criteria.
- Mean age at onset was 23.6 years; mean follow-up was 17.1 years.
- Utilized duplex scanning for brachiocephalic vessels; 6 patients had serial examinations.
Main Results:
- Subclavian artery involvement was universal; common carotid artery involvement occurred in 69%.
- Homogeneous circumferential intima-media thickening was common in stenotic common carotid arteries (89%).
- Sequential scans showed unpredictable progression, often with concentric thickening, predominantly on the left side.
Conclusions:
- Ultrasonographic findings in Takayasu's arteritis differ from atherosclerosis, with intima-media thickening being a specific sign.
- Duplex scanning is a valuable tool for diagnosing and monitoring Takayasu's arteritis.
- Vascular progression is unpredictable and warrants further investigation with duplex scanning for long-term follow-up.
Background And Purpose:
Takayasu's arteritis is an inflammatory vasculopathy involving the aorta and its major branches. Little information is available on the natural history and temporal profile of changes in the carotid vessels, the major vessels involved in Takayasu's arteritis. Duplex ultrasonography may provide a reliable and efficient tool for the characterization and follow-up of the brachiocephalic vascular changes in Takayasu's arteritis.
Methods:
Sixteen female patients fulfilling the clinical diagnostic criteria for Takayasu's arteritis were studied. Mean age at onset was 23.6 years (SD = 6.0), and mean duration of follow-up was 17.1 years (SD = 11.9). The clinical features were analyzed. Only one patient had had a stroke. They had undergone at least one duplex scanning examination to evaluate the brachiocephalic vessels, including the extracranial carotid, vertebral, and subclavian arteries. Six patients underwent sequential duplex examination and long-term clinical follow-up.
Results:
All the studied patients had subclavian artery involvement, and 11 (69%) had common carotid artery involvement. The percentage of bilateral concomitant involvement was 100% in the common carotid artery and 33% in the subclavian artery. Homogeneous circumferential intima-media thickening was commonly seen in stenotic common carotid arteries (89%). Four patients had internal carotid artery involvement (all on the left side). In the serial duplex follow-up study, 2 of 6 patients had progressive vascular stenosis with concentric thickening, rather than longitudinal spreading, in the bilateral common carotid arteries. Left-side lesions were more prominent. Most were clinically stationary, despite severe stenosis or occlusion of the common carotid arteries.
Conclusions:
The characteristic vascular lesions and progression changes in Takayasu's arteritis detected by duplex ultrasonography are quite different from those seen in ordinary atherosclerosis. Homogeneous circumferential intima-media thickening of the common carotid arteries is a highly specific ultrasonographic finding in patients with Takayasu's arteritis, particularly young women. Sequential duplex scanning showed vascular progression to be unpredictable and unrelated to medication in our patients. Further clinical investigations of vascular progression are warranted, and duplex scanning may provide a simple, safe, and accurate long-term means of follow-up.