Cervical duplex ultrasound for the diagnosis of giant cell arteritis with vertebral artery involvement

Kargiotis, Odysseas; Psychogios, Klearchos; Safouris, Apostolos; Bakola, Eleni; Andreadou, Elizabeth; Karapanayiotides, Theodoros; Finitsis, Stephanos; Palaiodimou, Lina; Giannopoulos, Sotirios; Magoufis, Georgios; Tsivgoulis, Georgios

doi:10.1111/jon.12857

Cited by 6 publications

(5 citation statements)

References 45 publications

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“…The incidence rate of ischemic stroke in patients with GCA has been repeatedly reported ranging between 2.8 and 7%. 1 2 3 4 5 6 7 The precision of determining this incidence rate might be influenced by the fact that also a TAB has a sensitivity between 70 and 90%. Consequently, the incidence rate of GCA-related strokes might have been underestimated in previous studies.…”

Section: Discussionmentioning

confidence: 99%

“…The incidence rate of ischemic stroke in patients with GCA has been repeatedly reported ranging between 2,8 and-7 % % [1][2][3][4][5][6][7]. The precision of determining this incidence rate might be influenced by the fact that also a TAB has a sensitivity between 70 and 90 %.…”

Section: Accepted Manuscriptmentioning

confidence: 99%

“…The incidence rate ranges between 2.8 and 7%. 1 2 3 4 5 6 7 Diagnosis can be challenging due to variable presentation and similarities with other inflammatory vessel diseases or causes of vascular stenosis.…”

Section: Introductionmentioning

confidence: 99%

“…Ischemic stroke in Giant cell arteritis (GCA) is a well-known complication. The incidence rate ranges between 2,8 and 7 % [1][2][3][4][5][6][7]Diagnosis can be challenging due to variable presentation and similarities with other inflammatory vessel diseases or causes of vascular stenosis.…”

mentioning

confidence: 99%

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Carotid Artery Stenosis and Ischemic Strokes in Patients with Giant Cell Arteritis

Oerding

Uhlmann

Kaden

et al. 2021

TH Open

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Purpose: Ischemic stroke is a relatively rare complication of giant cell arteritis often accompanied by vessel stenosis. Our purpose was to compare the location of internal carotid artery stenosis in GCA patients by performing a literature review suggesting a specific and characteristic pattern. Methods: We performed a Pubmed research including all articles and cited articles reporting cases and case series about giant cell arteritis patients with internal carotid artery stenosis and ischemic strokes. Results: In this case series 39 cases were included. We found a clear tendency of giant cell arteritis related stenosis to be in the intracranial segments (35/39 (89,7 %)). Only in 8/39 (20,5 %) patients there was further involvement of extracranial segments. Many cases (27/39 (69,2 %)) showed a bilateral involvement. Discussion: This literature review reveals a specific pattern of internal carotid artery involvement in patients with giant cell arteritis and ischemic strokes. To our knowledge this pattern has not been reported as a sign strongly pointing towards giant cell arteritis before. We have not found case reports mentioning other common types of vasculitis reporting this involvement pattern. Conclusion: Internal carotid artery stenosis and ischemic stroke is a rare complication in patients with giant cell arteritis. Considering the characteristic features of bilateral distal internal carotid artery stenosis giant cell arteritis should be suspected which potentially leads to an early diagnosis and immunotherapy.

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Section: Discussionmentioning

confidence: 99%

Section: Accepted Manuscriptmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

mentioning

confidence: 99%

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Carotid Artery Stenosis and Ischemic Strokes in Patients with Giant Cell Arteritis

Oerding

Uhlmann

Kaden

et al. 2021

TH Open

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“…Recent studies using positron emission tomography of radioactively labeled glucose (PET) or ultrasound (US) with experienced examiners and extended US protocols identified high rates of large-vessel involvement in GCA (6)(7)(8)(9). These findings seem important as they were associated with refractory disease and specific complications such as posterior stroke in vertebral vasculitis or thoracic aortic aneurysm in aortitis (10)(11)(12)(13)(14). New classification criteria incorporating these new imaging modalities have recently been published by the American College of Rheumatology (ACR) together with the European Alliance Of Associations For Rheumatology (EULAR) and proved to be applicable to GCA cohorts (15,16).…”

Section: Introductionmentioning

confidence: 99%

Vasculitis distribution and clinical characteristics in giant cell arteritis: a retrospective study using the new 2022 ACR/EULAR classification criteria

Andel,

Diamantopoulos,

Myklebust

et al. 2023

Front. Med.

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IntroductionGiant cell arteritis (GCA) is the most common vasculitis of the elderly. In recent years, advanced imaging has to a certain extent replaced temporal artery biopsy (TAB) to aid diagnosis in many institutions and helped to identify three major phenotypes of GCA, namely, cranial GCA (c-GCA), large-vessel non-cranial GCA (LV-GCA), and a combination of these two patterns called mixed-GCA, which all show different clinical patterns. Recent 2022 American College of Rheumatology (ACR)/European League Against Rheumatism (EULAR) classification criteria respect the changing conception and clinical practice during the last two decades. In this cohort study, we present vasculitis distribution and baseline characteristics using the 2022 ACR/EULAR classification criteria as well as the EULAR core data set.MethodsIn this retrospective study from Southern Norway, we identified all patients diagnosed with GCA between 2006 and 2019 in our single-center fast-track clinic (FTC). We included all patients who were examined using ultrasound (US) of cranial as well as non-cranial large vessels at diagnosis to depict vascular distribution. EULAR core data set, ACR 1990, and 2022 ACR/EULAR classification criteria were used to characterize the cohort.ResultsSeventy-seven patients were diagnosed with GCA at our institution in the aforementioned period. Seventy-one patients (92.2%) were diagnosed with the help of US and included in the further analysis. The 2022 ACR/EULAR classification criteria allocated 69 patients (97.2%), while the ACR 1990 classification criteria allocated 49 patients (69.0%) in our cohort as having GCA. Mixed-GCA was the most common type in 33 patients (46.5%). Weight loss was significantly more common in patients with large-vessel non-cranial vasculitis in LV-GCA and mixed-GCA. Headache, on the other hand, was significantly more common in patients with involvement of cranial vessels.ConclusionMixed GCA was the most common form of GCA in our cohort. In our study, the 2022 ACR/EULAR classification criteria seem to be a more useful tool compared with the old ACR 1990 classification criteria to allocate GCA patients diagnosed and treated at our US-based FTC as having GCA.

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Extended ultrasound examination identifies more large vessel involvement in patients with giant cell arteritis

Haaversen

Brekke²,

Kermani

et al. 2022

Rheumatology

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Objectives To compare limited, to a more extended ultrasound examination (anteromedial ultrasound, A2-ultrasound) to detect large vessels (LV) involvement in patients with newly diagnosed giant cell arteritis (GCA). Methods Patients with new-onset GCA were included at the time of diagnosis. All patients were examined using limited ultrasound (ultrasound of the axillary artery as visualized in the axilla), and extended A2-ultrasound method (which also includes the carotid, vertebral, subclavian, and proximal axillary arteries), in addition to the temporal artery ultrasound. Results One hundred and thirty-three patients were included in the study. All patients fulfilled the criteria according to a proposed extension of the 1990 American College of Rheumatology (ACR) classification criteria for GCA and had a positive ultrasound examination at diagnosis. Ninety-three of the 133 GCA patients (70,0%) had LV involvement when examined by extended A2-ultrasound, compared with only 56 patients (42,1%) by limited ultrasound (p< 0,001). Twelve patients (9.0%) had vasculitis of the vertebral arteries as the only LV involved. Five patients (3,8%) would have been missed as having GCA if only limited ultrasound was performed. Forty patients (30,0%) had isolated cranial GCA (c-GCA), 21 patients (15,8%) had isolated large vessel GCA (LV-GCA), and 72 patients (54,1%) had mixed-GCA. Conclusion Extended A2-ultrasound examination, identified more patients with LV involvement than limited ultrasound method. However, extended A2-ultrasound requires high expertise and high-end equipment and should be performed by ultrasonographers with adequate training.

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Cervical duplex ultrasound for the diagnosis of giant cell arteritis with vertebral artery involvement

Cited by 6 publications

References 45 publications

Carotid Artery Stenosis and Ischemic Strokes in Patients with Giant Cell Arteritis

Carotid Artery Stenosis and Ischemic Strokes in Patients with Giant Cell Arteritis

Vasculitis distribution and clinical characteristics in giant cell arteritis: a retrospective study using the new 2022 ACR/EULAR classification criteria

Extended ultrasound examination identifies more large vessel involvement in patients with giant cell arteritis

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