Balloon angioplasty of arteries of the upper extremities in patients with extracranial giant-cell arteritis

Abstract

Objectives: To evaluate the outcome of balloon angioplasty in the arteries of the upper extremities in patients with giant-cell arteritis (GCA) and stenosing extracranial involvement. Methods: Percutaneous transluminal angioplasty (PTA) for symptomatic upper limb artery stenoses (n = 29) and occlusions (n = 1) resistant to medical treatment was carried out in 10 patients (all women, mean age 65 years) with GCA. Vascular lesions were located in the subclavian (n = 4), axillary (n = 10) and brachial (n = 16) arteries. Interventional treatment was accompanied by immunosuppressive drugs in all patients. Follow-up included clinical and serological examination, magnetic resonance angiography and colour duplex ultrasound. Results: Initial technical success of angioplasty was achieved in the case of all vascular lesions. In five patients, marked recurrent stenoses (vascular territories; n = 10/30) were found during follow-up (mean 24 months). The cumulative primary patency rate was 65.2%. All recurrent lesions developed in the territories of the initial long-segment stenoses. Repeated PTA (vascular territories, n = 8; patients, n = 5) provided a cumulative secondary patency rate of 82.6% and a cumulative tertiary patency rate of 89.7%. Conclusions: Despite a tendency to restenoses, balloon angioplasty of the upper-extremity artery, in combination with immunosuppressive treatment, is an efficient method for the treatment of extracranial GCA.

Aortitis

“…Recently, endovascular therapy has been applied to select arterial occlusive lesions in patients with GCA with successful results in case series; however, the typical long-segment nature of the occlusive lesions of GCA is associated with a significant risk of restenosis. 127,128 …”

Giant Cell Arteritis

“…Though there is a relative paucity of studies in the literature, the technical and clinical success of percutaneous revascularization are similar to treatment of atherosclerotic disease which has been performed for more than 30 years. Several published reports describe both the immediate and long-term outcome of PTA in GCA patients with upper extremity symptoms (Dellaripa and Eisenhauer 1998;Amann-Vesti et al 2003;Both et al 2006;Short et al 2009). These case series describe balloon angioplasty of stenoses and/or occlusions involving the subclavian, axillary, and brachial arteries.…”

“…Technical success is defined by appearance on angiography, ultrasonography, or other imaging modalities, and/or the restoration of a radial pulse (Short et al 2009). Initial technical success is at or near 100% in all of the described cases with primary and secondary patency ranging from 65 to 89% (Amann-Vesti et al 2003;Both et al 2006;Short et al 2009). Patients who developed restenosis were managed successfully with repeat balloon angioplasty (Both et al 2006;Short et al 2009).…”

Acute Coronary Syndrome in a 52-Year-Old Woman With Scleroderma

“…[11][12][13][14][15][16][17] Although it is difficult to generalize these findings given the limited number of cases, complications of percutaneous revascularization similar to vasculitic lesions in noncoronary vessels resulting from large-vessel vasculitides such as Takayasu and giant-cell arteritis have been described more commonly, with high associated rates of restenosis and adverse vessel remodeling. [18][19][20][21] Although there is no clear consensus for the timing and role of revascularization in coronary vasculitis, the reported success with medical therapy and immunosuppression, in addition to the established complications of stenting other noncoronary vasculitic lesions, should prompt clinicians to consider an initial trial of medical therapy whenever clinically feasible. Long-term follow-up of patients with coronary vasculitis should include monitoring of disease activity and a low threshold to repeat coronary investigation for signs or symptoms concerning for myocardial ischemia.…”