Surgical treatment of cerebral ischaemia caused by cervical arterial lesions due to Takayasu's arteritis: preliminary results of 49 cases.

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The present paper reports the preliminary experience with surgical treatment of 49 cases of cerebral ischaemia caused by cervical arterial lesions due to Takayasu's arteritis (TA). Six men and 43 women were treated between June 1992 and October 1997. Their ages ranged from 15 to 42 years, with a mean of 26.5 years. Duration of symptoms was from 10 days to 8 years with a mean of 32 months. Bypasses from the ascending aorta to the axillary or subclavian artery and to the carotid artery were performed in 31 cases. Subclavian-to-carotid bypass was performed in six cases. Percutaneous transluminal angioplasty (PTA) was used in four cases. An excellent result was achieved in 28.6% of cases, a fair result was achieved in 36.7% of cases, improvement was achieved in 22.5% of cases, 2.0% of cases were unchanged, and in 10.2% of cases death occurred before discharge. During a mean follow up of 38 months these values were 26.2%, 42.8%, 16.7%, 4.8%, and 2.4%, respectively; recurrence occurred in 7.1% of cases. When cerebral perfusion is jeopardized, a definitive corrective procedure is advised at a time when the patient is in a relatively stable condition. Percutaneous transluminal angioplasty is the first choice although the recurrence rate is very high, and complications such as arterial rupture and thrombosis formation are serious. Patients with occlusive lesions of all four cervical arteries usually have severe cerebral ischaemia and their distal runoff is usually unable to be visualized on angiography. But it was found that in 95% of cases the internal carotid artery is still patent (confirmed by exploration), therefore an ascending aorta-to-carotid bypass is feasible in most instances. Unfortunately, cerebral re-perfusion syndrome is a serious unresolved problem.