Treatment Of Takayasu Arteritis Research Articles

Surgical Treatment of Ruptured Aneurysm of the Left Sinus of Valsalva Caused by Takayasu Arteritis

Takayasu arteritis is a chronic large-vessel vasculitis that is more frequently observed in young women. We report the case of a 29-year-old woman who required an operation for an aneurysm of the left sinus of Valsalva that ruptured into the left ventricle, for aortic regurgitation, and for left main coronary trunk stenosis. The patient had not been previously diagnosed with Takayasu arteritis.

Development of Takayasu Arteritis Despite Existing Treatement of Etanercept and Questionable Paradoxical Effect: Case Report and Review of Literature

Although glucocorticoids are the standard treatment in patients with Takayasu arteritis, significant data suggest that etanercept, as well as other anti-tumor necrosis factor alpha (anti-TNF) agents, are effective in refractory cases. We report what we believe to be the first case in literature in which a patient who was on active treatment of etanercept for psoriatic arthritis, developed Takayasu arteritis. Although this case report is not intended to conflict with the previous data that support the beneficial role of ant-TNF agents in the treatment of Takayasu arteritis, it does show that a certain patient might still develop Takayasu arteritis despite being on active treatment of etanercept. We also cannot conclude from this case that Takayasu arteritis was triggered by etanercept. However, such a possibility remains in question. doi:10.4021/jmc2w

Takayasu’s arteritis mimicking Kawasaki disease in 7-month-old infant, successfully treated with glucocorticosteroids and intravenous immunoglobulins

Takayasu's arteritis (TA) rarely occurs in infants. There are only four reports on TA in children below 1 year of age, revealing diversity of its symptoms. We describe a 7-month-old female infant hospitalized for hectic fever, irritability, high acute phase indices, and coronary artery dilatations found on echocardiography, which suggested Kawasaki disease (KD). Despite of standard treatment, rapid development of thoracic and abdominal aorta aneurysms occurred, while coronary artery abnormalities regressed. The initial diagnosis was changed for TA. Subsequently implemented glucocorticosteroids led to clinical and laboratory normalization. However, 2 months after treatment discontinuation, TA relapsed. Glucocorticosteroid therapy was restarted with additional introduction of intravenous immunoglobulins (IVIG), resulting in full and stable remission lasting over 1 year. Thus, diagnosis and treatment of infant TA pose a big challenge to physicians. TA onset in infants may mimics KD. Prolonged glucocorticosteroids and IVIG administration can be recommended in the youngest patients with TA.

Antiplatelet Therapy in the Treatment of Takayasu Arteritis

Antiplatelet Therapy in the Treatment of Takayasu Arteritis

Development of Takayasu Arteritis Despite Existing Treatement of Etanercept and Questionable Paradoxical Effect: Case Report and Review of Literature

Although glucocorticoids are the standard treatment in patients with Takayasu arteritis, significant data suggest that etanercept, as well as other anti-tumor necrosis factor alpha (anti-TNF) agents, are effective in refractory cases. We report what we believe to be the first case in literature in which a patient who was on active treatment of etanercept for psoriatic arthritis, developed Takayasu arteritis. Although this case report is not intended to conflict with the previous data that support the beneficial role of ant-TNF agents in the treatment of Takayasu arteritis, it does show that a certain patient might still develop Takayasu arteritis despite being on active treatment of etanercept. We also cannot conclude from this case that Takayasu arteritis was triggered by etanercept. However, such a possibility remains in question. J Med Cases. 2010;1(1):37-38 doi: https://doi.org/10.4021/jmc2w

Infliximab therapy for three adolescent patients with refractory Takayasu's arteritis

Takayasu's arteritis (TA) is a chronic idiopathic inflammatory disease affecting primarily aorta and its proximal branches. Pediatric patients with TA tend to have more severe clinical course and be refractory to conventional treatments compared with adults. Corticosteroids are major treatment of TA, however, high dose is required to get remission. Particularly, adolescent patients are usually suffering from side-effects of excessive dose of corticosteroids. Immunosuppressants are added expecting the corticosteroid sparing agents. However, some patients, such as HLA-B52 positive, tend to be registant to these conventional treatments. Recently, several reports showed the efficacy of Infliximab, anti-tumor necrosis factor (TNF) alpha monoclonal antibody, for adult patients with refractory TA. We described three cases of adolescents with TA treated with Infliximab. It was initially effective in all three patients. However, serious infusion reaction occurred in one of them during 11(th) times of Infliximab infusion and she discontinued the therapy. Other two patients showed good response in initial phase, but clinical manifestations and laboratory findings became worse after several months. In these patients with secondary failure to Infliximab, increased dosage and shortening the interval of infusions provided effectiveness again. Infliximab would be a good choice for adolescent patients with TA refractory to conventional treatments. However, we should carefully monitor safety and efficacy of this agent considering its peculiarity.

New insights into the pathogenesis and treatment of Takayasu arteritis

Takayasu arteritis (TA) is a rare, chronic inflammatory disease that mainly affects the aorta and its primary branches. Initially described in young women from the Far East, it has become evident that TA is found worldwide, in both genders, and in a broader age range of patients than previously appreciated. Although the pathogenesis of TA remains unknown, current evidence suggests an autoimmune etiology. The immune response to pathogen exposure has been purported as a potential etiological factor, and current investigations continue to explore this hypothesized trigger of disease. Prior cohort studies document the relapsing, refractory nature of TA and the limitations of currently utilized therapies, although advances in immunosuppressive therapy may lead to better outcomes in patients with TA. Furthermore, newer diagnostic imaging modalities have provided a more comprehensive picture of this disease, and may aid in earlier diagnosis and better surveillance of disease activity and response to therapy.

Serial imaging changes during treatment of Takayasu arteritis with pulmonary artery stenosis

Most cases of chronic stenosis or occlusive lesions of the pulmonary arteries are attributed to thromboembolism, and pulmonary arteritis is extremely rare as the primary cause of these entities. We report a case of pulmonary stenosis and occlusion caused by Takayasu arteritis. The patient was a 54-year-old woman who presented with dyspnea. Total occlusion of the left pulmonary artery and significant stenosis of the right pulmonary artery caused by Takayasu arteritis were confirmed by various imaging modalities including pulmonary angiography, 18fluorodeoxyglucose-positron emission tomography, magnetic resonance imaging and real-time three-dimensional transesophageal echocardiography. After 6 weeks of steroid therapy, follow-up imaging studies showed that the stenotic lesion had resolved.

L’artérite de Takayasu : mise au point à propos d’une série monocentrique de 82 patients

Takayasu arteritis (TA) is an uncommon large-vessel arteritis. We report our French single-center experience in the management of patients with TA (Pitié-Salpêtrière Hospital, Paris). TA is diagnosed in patients presenting with a large-vessel arteriopathy, in whom several inflammatory and non-inflammatory differential diagnoses are ruled out by appropriate investigations. Treatment of active disease is primarily based on corticosteroids but other immunosuppressive drugs are frequently needed. Anti-platelets agents, statins and antihypertensive drugs are frequently considered. There is no validated disease activity criterion in TA; thus, we generally consider the disease as being active in the presence of the following criteria: firstly, the presence of constitutional or ischemic symptoms; secondly, the increased acute phase reactants; thirdly, the mural contrast enhancement in CT-scan or fourthly, the mural contrast enhancement or signal abnormalities in MRI; fifthly, the abnormal vascular uptake in PET-scan. When TA is active, our follow-up recommendation is to perform an ultrasonography of the supra-aortic vessels and an aortic MRI or CT-scan twice a year. When TA appears to be inactive, we recommend to perform these investigations once a year. Surgical treatment of TA is limited to a few indications. The overall prognosis of TA is good but the quality of life is altered. Management of TA patients is difficult because of the lack of reliable diagnostic criteria, consensual therapeutic strategies and validated disease activity criteria. Further studies should focus on the pathogenesis of the disease and help define better disease activity criteria.

Overview of Late Outcome of Medical and Surgical Treatment for Takayasu Arteritis

Takayasu arteritis (TA), which is a nonspecific inflammatory disease of unknown origin, causes various types of aortoarterial stenosis/occlusion or dilatation (Figure). Historically, Mikito Takayasu, a Japanese ophthalmologist, described a peculiar wreathlike arteriovenous anastomosis around the papillae of the retina (Takayasu disease) in 1908.1 In the first necropsy case reported in 1940, this ophthalmologic finding was related to cervical vessel occlusion.2,3 Subsequently, this nonspecific panarteritis that affects the intima and the adventitia of the aorta and its main branches was called Takayasu arteritis . Its clinical manifestations are varied and related to the vessel that presents the stenotic or occlusive lesions, such as the aortic arch (pulseless disease),4 descending thoracic or abdominal aorta (atypical coarctation),5 renal arteries,6 coronary arteries,7 and pulmonary arteries. Aortic aneurysm8 and aortic valve regurgitation with ascending aortic dilatation9 may also develop in some instances. Pharmacological treatment with corticosteroids is usually the initial treatment. Some patients require surgical treatment such as bypass grafting and graft replacement or endovascular repair including percutaneous transluminal angioplasty (PTA) and stent grafting, even in the active phase or in the inactive chronic phase with adequate control of the inflammation. Since the 1960s, acceptable early and midterm outcomes of medical and/or surgical treatment have been published. However, the long-term outcome, including that of recently developed endovascular treatment, has not been discussed. In this article, we describe an overview, particularly focusing on the late outcome of treatment for TA. Figure. Three-dimensional computed tomographic findings of an active phase of Takayasu arteritis (21 years, female). Three-dimensional computed tomographic findings include multiple stenotic lesions on the carotid and subclavian arteries (A), aneurysmal dilatation of the ascending aorta to the aortic arch and of the main pulmonary artery (B), aneurysmal dilatation of the descending aorta, stenosis of the right renal …

Takayasu Arteritis in Children: Preliminary Experience with Cyclophosphamide Induction and Corticosteroids Followed by Methotrexate

To review the results of our treatment protocol in the last 7 years. Six patients (4 girls, 2 boys) with an age range of 12 to 17 years were diagnosed with Takayasu arteritis (TA) during this period. Patients were allocated to receive (1) oral steroids and methotrexate (MTX) (12.5 mg/m(2)/week) if they had disease limited to one side of the diaphragm only without pulmonary disease involvement (two patients); and (2) oral steroids and oral cyclophosphamide (CYC) (maximum total dose 150 mg/kg) followed by oral MTX for maintenance as above if the disease was more widespread (four patients). One patient died of pulmonary vasculitis during the first month of therapy. The remaining three patients with involvement of both the thoracic and abdominal aorta and branches received the second protocol for 12 to 18 months. All entered remission. Aortic bypass, aortorenal bypass, balloon dilatation, and unilateral nephrectomy were performed in these patients. The presented single-center experience suggests that CYC induction and corticosteroids followed by MTX is an effective and safe treatment for childhood TA.

Infliximab in Takayasu arteritis: a safe alternative?

To test the efficacy of Infliximab, a chimeric monoclonal antibody against TNF-alpha, in the treatment of Takayasu arteritis. We used infliximab at an initial dose of 3 mg/kg i.v. at weeks 0, 2, 6, and 8 thereafter in combination with methotrexate or azathioprine, to treat four patients with Takayasu arteritis. Three out of four patients responded to infliximab treatment, while two of them retained the response during a two-year follow up. A higher dose regimen (5 mg/kg), however, was eventually warranted for two of the responders. No major side effects were noted. Infliximab might be an effective and safe alternative for patients with Takayasu arteritis.

Minocycline for the Treatment of Takayasu Arteritis

Minocycline for the Treatment of Takayasu Arteritis

Direct medical costs of monitoring and treating patients with Takayasu arteritis in Italy.

The study provides the first overall estimate of the costs of Takayasu arteritis (TA) monitoring and treatment in Italy and highlights the differences in cost components across defined subgroups of patients. We estimated resource consumption and direct costs from the Italian National Health Service perspective. We conducted a multicenter, prospective study in 12 medical departments. All the 67 patients recruited met the American College of Rheumatology 1990 criteria for the classification of TA and were followed up for 1 year. For the purpose of analysis they were divided into two groups: "active TA" (patients who had taken at least one drug specific for TA treatment, i.e., corticosteroids and/or cytotoxics), and "inactive TA" (all the remaining patients). The average cost per year was Euro 4,079. Patients with active TA (Euro 5,055) had a significantly higher mean cost per year than those with inactive TA (Euro 1,328). In particular, significant differences were found for costs in general practitioner consultations, laboratory tests, and hospital admissions. These findings suggest that patients not only experience more complications requiring hospital admissions but also see general practitioners more often during the active stage of the disease, presumably in order to obtain a prescription for laboratory tests.

M.585 Minocycline has a steroid-sparing effect in treatment of Takayasu arteritis

M.585 Minocycline has a steroid-sparing effect in treatment of Takayasu arteritis

M.585 Minocycline has a steroid-sparing effect in treatment of Takayasu arteritis

M.585 Minocycline has a steroid-sparing effect in treatment of Takayasu arteritis

Treatment of takayasu arteritis in the chronic stages: An analysis of 14 operated patients

Treatment of takayasu arteritis in the chronic stages: An analysis of 14 operated patients

Multiple Stenting in Takayasu Arteritis

To illustrate the possible peri- and postprocedural complications of stent treatment for Takayasu arteritis and suggest ways of reducing these risks. A 69-year-old woman with Takayasu arteritis had multiple stents implanted in the aortic arch (3 Memotherm) and main branches of the thoracic aorta (individual Corinthian stents in the subclavian and brachiocephalic arteries) following balloon dilation. She suffered reperfusion injury with cerebral hemorrhage following the procedure, preventing the use of anticoagulation or antiplatelet therapy. Further cerebral infarctions/hemorrhages over the ensuing months led to her death. Severe vascular disease of any cause confers a poor prognosis. Endovascular stenting may seem an attractive option for management of these patients, but there is often significant morbidity and mortality associated with the underlying disease as well as the stent.

Takayasu arteritis: Utility and limitations of magnetic resonance imaging in diagnosis and treatment

Previous studies have confirmed the poor correlation of symptoms, signs, and levels of acute-phase reactants with disease activity in approximately 50% of all patients with Takayasu arteritis (TA). Invasive angiographic studies demonstrate vessel lumen anatomy, but do not provide qualitative information about the vessel wall. Moreover, sequential invasive angiographic studies expose patients to high-dose ionizing radiation and catheter/procedure-related morbidity. The aim of the present study was to determine the utility of new developments in vascular magnetic resonance (MR) technology in patients with TA. Electrocardiogram-gated "edema-weighted" MR was used to evaluate the aorta and its primary branches with regard to the vascular lumen, vessel wall anatomy, and vessel wall edema in 24 TA patients (77 studies). Inclusion criteria were age <50 years and features of TA on both clinical examination and invasive angiographic studies. Patients were stratified based on clinical and laboratory indications of having either unequivocally active disease, inactive disease, or uncertain disease status. MR revealed vessel wall edema in 94% (17 of 18), 81% (13 of 16), and 56% (24 of 43) of studies obtained during periods of unequivocally active disease, uncertain disease activity, and apparent clinical remission, respectively. Westergren erythrocyte sedimentation rate and C-reactive protein values did not correlate with either the clinical assessment of disease activity or MR evidence of vascular edema. The frequency of presumed vascular inflammation (edema), as assessed by MR, in patients who appeared to be in remission was similar to the reported frequency of new angiographic lesions and histopathologic evidence of active disease in surgical specimens from patients thought to be in remission. However, the presence of edema within vessel walls did not consistently correlate with the occurrence of new anatomic changes found on subsequent studies. Inconsistencies in the presence or absence of vessel edema and subsequent anatomic changes have cast doubt on the utility of edema-weighted MR imaging as a sole guide to disease activity and treatment in TA. In this study, the greatest utility of MR was in providing a safe, noninvasive means of assessing changes in vascular anatomy.

Takayasu arteritis: diagnosis with MR imaging and MR angiography in acute and chronic active stages.

Early diagnosis and treatment of Takayasu arteritis is important in prevention of serious complications. Spin-echo magnetic resonance imaging (MRI) can depict early wall thickening of the aorta and cine MRI can evaluate aortic valve function. Significant enhancement in and around the aorta and carotid arteries is observed on postcontrast MR images in acute phase Takayasu arteritis. In the chronic phase, contrast enhancement in the aortic wall stronger than in the myocardium suggests activity of the disease. Breath-hold contrast-enhanced three-dimensional MR angiography is very effective in noninvasive evaluation of luminal change of aortitis. Contrast-enhanced MRI and MR angiography have an important role in early diagnosis, activity determination, and follow-up of Takayasu arteritis. MRI and MR angiography can be utilized for initial diagnosis of Takayasu arteritis and replace catheterization angiography. J. Magn. Reson. Imaging 1999;10:751-757.