The experience of comprehensive conservative and endovascular management of Takayasu arteritis, manifested with repeated ischemic strokes

Abstract

Introduction: Takayasu arteritis or nonspecific aortoarteritis (TA) is a rare, chronic granulomatous panarteritis, which most often caused vascular stenosis. The inflammation activity control is the main treatment goal, which prevents of blood vessels further damage. But existing stenosis could cause ischemia. Nevertheless, the exact recommendations for recanalization occluded and stenosed vessels are absent. Results: A clinical case, which demonstrated the experience of treatment TA, manifested by repeated ischemic strokes, is presented. Total selective cerebral angiography revealed multifocal stenotic lesions of aorta large branches (subtotal stenosis of the right subclavian artery, 85% stenosis of the right common carotid artery (CCA), 75% stenosis of the right vertebral artery (VA) and occlusion of the left CCA) with significant decrease in cerebral blood flow in the left carotid circulation regions. Endovascular angioplasty of stenoses of the right subclavian, right VA and right CCA was done at the time of minimal activity of the process. Drug-eluting stents were used to reduce restenosis risk. Szabo technique, which made it possible to accurately dispose the stent, was used for right VA stenting. Distally anti-embolic protection system was used. There was no any peri- and postoperative complications. After 6 months, hemodynamic reorganisation leads to perfusion improvement. Follow-up examination 18 month after intervention: without negative dynamics in neurological status, there are no evidence of restenosis or new stenosis. Biochemical analyzes revealed a low activity of the inflammatory process. However, immunosuppressive therapy was continued. Conclusions: The results of vascular intervention in TA can be improved by providing optimal immunomodulating therapy before and after the procedure. Individual approach to choice of surgical strategy and using drug-eluting stents, the Szabo technique and distally anti-embolic protection allows to obtain good treatment results. Conducting further large studies are needed to recommend wider use of described technique.