Abstract
Takayasu arteritis (TA) is a chronic inflammatory disease involving the aorta and its principal branches. Acute ischaemic stroke (AIS) as the initial manifestation of TA is uncommon. There is little evidence on the efficacy of bridging therapy for AIS induced by TA. A 23-year-old Chinese woman with a suspected stroke presented to our hospital with sudden onset of right-sided weakness, right facial palsy, and aphasia that occurred 1 hour ago. After physical and ancillary examinations, recombinant tissue plasminogen activator was administered to the patient, which led to partial recovery. Her neurological function deteriorated with a large salvageable ischaemic penumbra on computed tomography perfusion. Cerebrovascular angiography showed multiple stenoses in the brachiocephalic trunk, the beginning of the right common carotid artery (CCA), and the bilateral subclavian arteries, as well as occlusion of the left CCA and its branches. Mechanical thrombectomy of the left middle cerebral artery was performed immediately. Percutaneous transluminal balloon angioplasty of the left CCA followed by stent implantation of the proximal left CCA was then performed. A diagnosis of TA was made based on the findings. The patient’s neurological deficit fully recovered with immunosuppressants at the 3 month-follow-up. We report a rare case of a patient with TA initially presenting with AIS treated with bridging therapy with full recovery of neurological function. Bridging therapy should be taken into consideration for AIS in patients with TA. Further study is needed in this regard.
Highlights
Takayasu arteritis (TA) is a chronic large vessel inflammatory disease involving the aorta and its principal branches, leading to stenosis and occlusion of the vessels [1]
Mechanical thrombectomy and/or thrombolysis therapy are the gold standard treatments for acute ischaemic stroke (AIS) within the time window, there is little published evidence on mechanical thrombectomy and/or thrombolysis therapy for AIS induced by TA
We present a case of TA presenting with AIS as an initial manifestation, which was successfully treated with bridging therapy with intravenous thrombolysis and subsequent mechanical thrombectomy
Summary
Takayasu arteritis (TA) is a chronic large vessel inflammatory disease involving the aorta and its principal branches, leading to stenosis and occlusion of the vessels [1]. Computed tomography angiography (CTA) of the head showed asymmetry of the internal carotid arteries (left smaller than the right) and an abrupt occlusion of the M1 branch of the left MCA (Figure 2B). Digital subtraction angiography (DSA) showed multiple stenoses in the brachiocephalic trunk, the beginning of the right common carotid artery (CCA), and the bilateral subclavian arteries, as well as occlusion of the left CCA and its branches (Figure 4A). Methylprednisolone (16 mg/day), azathioprine (100 mg/day), aspirin (100 mg/day), and atorvastatin (20 mg/day) were introduced as extended duration treatments (Figure 1) Her symptoms, including hemiplegia, facial nerve palsy, and aphasia, gradually improved. Restenosis was not found on left carotid artery CT examination at the 1-year follow-up. Brain magnetic resonance imaging showed an old infarct lesion in the left basal ganglia and normal intracranial arteries
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