Percutaneous Revascularization of Sole Arch Artery for Severe Cerebral Ischemia Resulting from Takayasu Arteritis

Abstract

Takayasu arteritis (TA) is a rare form of inflammatory arteriopathy affecting the aorta and its major branches. Obstructive lesions of all arch vessels may lead to disabling neurologic symptoms. There is limited experience with endovascular revascularization in this situation. The present report describes immediate and follow-up results with stent-supported angioplasty of severely stenosed single patent arch arteries. Angioplasty and stent placement were performed in 10 consecutive patients with TA (age, 11-42 years; mean, 28.3 y +/- 4.1) with cerebrovascular symptoms caused by severe stenotic lesions of supraaortic (ie, carotid, vertebral, and brachiocephalic) arteries. Angioplasty was attempted in 12 stenotic lesions: carotid (n = 8), vertebral (n = 2), and brachiocephalic (n = 2). Eight lesions were discrete and four were diffuse. Balloon angioplasty and stent implantation were performed successfully in all patients. The luminal diameter increased from 0.84 mm +/- 0.6 to 5.6 mm +/- 0.7 (P < .001), and the diameter of stenosis was reduced from 81.1% +/- 6.8% to 1.7% +/- 3.3% (P < .001). No immediate procedure-related complication or neurologic deficits occurred. The symptoms improved in all patients. On follow-up (mean, 25 months +/- 7; range, 3-49 months), eight patients were asymptomatic and two patients with diffuse stenosis had recurrence of neurologic symptoms. These patients had in-stent restenosis of the carotid artery, which was successfully treated with cutting balloon angioplasty. Stent-supported angioplasty of a sole supraaortic artery in TA is safe and effective and provides good symptomatic relief in patients with multiple stenoocclusive lesions of arch arteries.