Abstract
Takayasu's arteritis (TA) is a chronic progressive vasculitis affecting large and medium-sized vessels, mainly in young subjects. It is most common in women with a higher prevalence in the Asian population. Stroke is a rare complication of TA, and these patients usually have a poor therapeutic response to revascularization treatments (thrombolysis and/or thrombectomy). We report a case of a male patient aged between 40 and 50 years admitted to our Emergency Department's Stroke Unit for sudden left hemiplegia, hypoesthesia, and dysarthria caused by right internal carotid artery (ICA), middle cerebral artery (MCA), and anterior cerebral artery (ACA) occlusion. He was treated with intravenous thrombolysis (r-tPA), endovascular carotid stenting, and thromboaspiration. We also revealed subclavian stenosis, vascular bruit, erythrocyte sedimentation rate (ESR), and C-reactive protein (CRP) elevation; therefore, a diagnosis of TA was made. Double antiplatelet therapy (DAPT) was started. Despite the early post-procedural carotid stent occlusion, the patient was discharged with a full recovery (neurological index of stroke scale [NIHSS] = 0). Thefive5-year clinical follow-up showed no clinical neurological relapses, and no arterial restenosis was found by further carotid artery echo-Doppler. Takayasu arteritis is a rare cause of ischemic stroke in young adults; however, stroke may be the first manifestation of the disease. Guidelines concerning the role of revascularization treatment in this type of patients are unclear. In this regard, the clinical experience and the multidisciplinary approach applied in our case had a pivotal role. Such an approach would eventually advocate for standardized treatment in patients with stroke and TA.
Highlights
We present a rare complication of Takayasu’s arteritis (TA) manifesting as an acute ischemic stroke refractory to revascularization treatments
We report a case of a male patient aged between 40 and 50 years admitted to our Emergency Department's Stroke Unit for sudden left hemiplegia, hypoesthesia, and dysarthria caused by right internal carotid artery (ICA), middle cerebral artery (MCA), and anterior cerebral artery (ACA) occlusion
The clinical experience and the multidisciplinary approach applied in our case had a pivotal role
Summary
We present a rare complication of Takayasu’s arteritis (TA) manifesting as an acute ischemic stroke refractory to revascularization treatments. A Caucasian male patient aged between 40 and 50 years, a smoker, without other vascular risk factors, was admitted to the emergency department (ED) because of acute onset of left hemiplegia, hypoesthesia, and dysarthria. He had no known family history of cardiac, cerebrovascular, or rheumatologic disease. The DSA of the left internal carotid artery (b) showed occlusion of the M1 segment of the right middle cerebral artery (arrow) with good leptomeningeal collateral from the left side (c). A brain magnetic resonance image (MRI) showed ischemic lesions involving right lenticular and basal ganglia and a right tandem occlusion of the internal carotid and tract M1 of the middle cerebral artery (Figure 2). After a five-year follow-up, the patient was still in good clinical condition, and there was no relapse of the disease
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