Post-interventional immunosuppressive treatment and vascular restenosis in Takayasu's arteritis

Park, M. C.; Lee, S. W.; Park, Y. B.; Choi, Donghoon; Shim, Won-Heum

doi:10.1093/rheumatology/kei245

Cited by 111 publications

(67 citation statements)

References 34 publications

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“…Percutaneous transluminal angioplasty/ stenting has been reported to have a higher restenosis rate in the Indian cohort compared with the other reports (12%-71.4%) (26,28). The restenosis rate was reduced when surgical treatment was performed during the inactive stage of the disease and under treatment with both glucocorticoids and immunosuppressive (IS) agents (29)(30)(31). These data suggest that early immunosuppression and choice of treatment may be influencing the different rates of outcome in the literature.…”

Section: Prognosismentioning

confidence: 84%

Recent advances in Takayasu's arteritis

Alıbaz-Öner¹,

Aydın²,

Direşkeneli³

2015

Eur J Rheumatol

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Takayasu's arteritis (TAK) is a rare, chronic large-vessel vasculitis (LVV) that predominantly affects the aorta, its major branches, and the pulmonary arteries. Recent advances in the diagnosis, clinical course, disease assessment with biomarkers/imaging and new clinical tools, patient-reported outcomes, and new treatment options of TAK are discussed in this review. Conventional angiography, the gold standard method for initial diagnosis, appears to have been replaced with new imaging modalities such as magnetic resonance angiography (MRA) and 18F-fluorodeoxyglucose positron emission tomography (FDG-PET) in recent years. MRA and FDG-PET are also promising for the assessment of disease activity. New tools for disease assessment such as Indian Takayasu's Arteritis Score 2010 (ITAS2010) and color Doppler ultrasound (CDUS) aim to better characterize and quantify disease activity; however, different imaging modalities in routine follow-up are not incorporated sufficiently in these approaches. Prognosis is possibly getting better, with lower mortality in recent years; however, it is difficult to assess the widely different vascular intervention rates among the clinical series. Leflunomide, tumor necrosis factor (TNF)-α antagonists, and tocilizumab are new options for patients resistant to conventional therapies. There is a clear need to develop a validated set of outcome measures for use in clinical trials of TAK. The Outcome Measures in Rheumatology (OMERACT) Vasculitis Working Group has taken on this task, finished a Delphi exercise with experts, and aims to develop a core set of outcomes for LVV in accordance with OMERACT Filter 2.0.

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Section: Prognosismentioning

confidence: 84%

Recent advances in Takayasu's arteritis

Alıbaz-Öner¹,

Aydın²,

Direşkeneli³

2015

Eur J Rheumatol

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“…First, selecting the timing of the procedure: PTA and stent implantation should not be performed at the stage of active inflammation. Pack et al 17 observed that the restenosis rate was lower when vascular interventions were performed at the stable stage of TA. Second, selecting proper balloon and stent: balloon inflation at high pressure is required for rigid stenotic lesions in pulmonary arteritis.…”

Section: Discussionmentioning

confidence: 99%

Percutaneous Transluminal Angioplasty and Stenting for Pulmonary Stenosis Due to Takayasu's Arteritis: Clinical Outcome and Four‐year Follow‐up

Luo

Zhang

Liu

et al. 2009

Clinical Cardiology

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Background: Percutaneous transluminal angioplasty and stent implantation for stenotic lesions of renal arteries and other branches of the aorta in Takayasu's arteritis have been reported to show good outcomes. However, this form of therapy has been reported in few cases with pulmonary artery involvement. Hypothesis: The aim of this study was to evaluate the role of this interventional treatment for pulmonary stenosis due to Takayasu's arteritis. Methods: A total of 4 patients (3 female and 1 male, ages 30-40 yrs) with Takayasu's pulmonary arteritis underwent percutaneous transluminal balloon angioplasty and stent implantation and were followed up for 1 to 4 years. Results: One patient underwent balloon angioplasty alone, 3 patients underwent balloon angioplasty and stent implantation. The stenoses were relieved acutely, oxygen saturation improved immediately due to improvement in lung perfusion and relief of dyspnea. The pressure gradient fell from 58.3 ± 8.7 mm Hg to 14 ± 3.2 mm Hg and mean pulmonary arterial pressure decreased from 48.5 ± 12.0 mm Hg to 37.3 ± 6.0 mm Hg. At a follow-up period of 34.5 ± 15.8 months, the patient with balloon angioplasty alone developed a recurrence of symptoms 18 months after the procedure. The other 3 patients continued to be asymptomatic and the stent remained patent without restenosis after the procedure. Conclusion: Percutaneous transluminal angioplasty and stent implantation is a safe and effective treatment in patients with pulmonary stenosis caused by Takayasu's arteritis.

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“…O acompanhamento pós-operatório desses pacientes deve ser com consultas de rotina, monitoramento da pressão arterial, provas de atividade inflamatória e exames de imagens da aorta e seus ramos para diagnosticar novas lesões estenóticas passíveis de tratamento, já que mesmo com a doença controlada clinicamente as lesões arteriais podem continuar progredindo e sendo necessário outras intervenções 1,3,5,6,14 .…”

Section: Discussionunclassified

Tratamento endovascular da síndrome da aorta média causada por arterite de Takayasu: relato de caso

et al. 2009

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IntroduçãoA arterite de Takayasu (AT) é uma doença vascular inflamatória crônica de etiologia desconhecida que se caracteriza por provocar lesões definitivas nos grandes vasos, ramos diretos da aorta, principalmente os supra-aórticos, podendo acometer inclusive a artéria pulmonar. Predomina em mulheres (9:1) jovens (15-25 anos) de descendência asiática. As lesões da aorta e seus ramos podem ser aneurismáticas ou estenótico-oclusivas 1-3 . Das artérias parietais, a mais acometida é a artéria subclávia esquerda e, das viscerais, as artérias renais. Daí a associação da AT com a hipertensão renovascular. O tratamento está baseado:1) no controle da atividade da doença através dos imunossupressores;2) na correção cirúrgica nas lesões estenótico-oclusivas longas ou quando há o acometimento de vários ramos viscerais;3) ou no tratamento endovascular através de angioplastia e/ou implante de stent 1,3-5 .A terapêutica endovascular é efetiva no tratamento da estenose da aorta e seus ramos parietais e viscerais, principalmente nas lesões ostiais 3 . É sabido também que a progressão da doença é responsável pelas altas taxas de recidiva precoce, principalmente em se tratando das artérias renais 1,3,6 .O portador de AT pode cursar com manifestações clí-nicas diversas a depender da localização do comprometimento arterial. As lesões podem ser classificadas em quatro tipos: tipo I (Shimizu-Sano), envolvimento do arco aórtico e seus ramos; tipo II (Kimoto), envolvimento da aorta torácica descendente e da aorta abdominal sem comprometimento do arco aórtico; tipo III, comprometimento arterial dos tipos I e II; tipo IV, comprometimento arterial RELATO DE CASO ResumoSíndrome da aorta média (SAM) é uma condição clínica caracterizada por estenose segmentar ou difusa da aorta, hipertensão arterial e claudicação de membros inferiores. A principal causa da SAM é a arterite de Takayasu. A estenose segmentar pode estar localizada na aorta suprarrenal, renal ou infrarrenal e com alta propensão de lesões estenóticas concomitantes das artérias renais e viscerais. A gravidade da hipertensão arterial é a principal indicação para o tratmento. A técnica endovascular para o tratamento da síndrome da aorta média tem bons resultados e é a menos invasiva. No presente artigo, é descrito o tratamento com sucesso de uma estenose da aorta toracoabdominal com recanalização da artéria mesentérica superior através de angioplastia em uma mulher de 34 anos portadora de arterite de Takayasu e hipertensão arterial grave.Palavras-chave: Arterite de Takayasu, angioplastia com balão, stents, aorta abdominal, obstrução da artéria renal, artérias viscerais. AbstractMiddle aortic syndrome (MAS) is a clinical condition characterized by segmental or diffuse narrowing of the aorta, hypertension, and lower limb claudication. The main cause of MAS is Takayasu's arteritis. Segmental aortic stenosis may be located at the suprarenal, renal or infrarenal aorta with high tendency to concomitant stenosis in both the renal and visceral arteries. Severity of hypertension is the pri...

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Post-interventional immunosuppressive treatment and vascular restenosis in Takayasu's arteritis

Abstract: Restenosis occurred in 31.7% of TA patients after intervention. A lower restenosis rate was observed when the vascular interventions were performed at the stable stage and when post-interventional immunosuppressive treatment was implemented.

Cited by 111 publications

References 34 publications

Recent advances in Takayasu's arteritis

Recent advances in Takayasu's arteritis

Percutaneous Transluminal Angioplasty and Stenting for Pulmonary Stenosis Due to Takayasu's Arteritis: Clinical Outcome and Four‐year Follow‐up

Tratamento endovascular da síndrome da aorta média causada por arterite de Takayasu: relato de caso

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