Retrospective Analysis of Surgery Versus Endovascular Intervention in Takayasu Arteritis: A Multicenter Experience

Abstract

CEA. The authors preformed an evaluation of perioperative and long-term outcomes of CAS and CEA in patients with previous cervical radiation therapy. They used a systematic search strategy with the synonyms "carotid artery stenosis" and "cervical irradiation" in MEDLINE and Embase databases. Pooled and meta-regression analysis was performed to provide and compare estimates of outcomes. There were 27 articles comprising 533 patients undergoing radiation therapy (361 CAS and 172 CEA) that fulfilled inclusion criteria. Pooled analysis showed a perioperative risk for any cerebral vascular adverse event (CVAE) of 3.9% (95% confidence interval [CI], 2.3%-6.7%) in CAS studies vs 3.5% (95% CI, 1.5%-8.0%) in CEA studies (P ϭ .77). Risk for cranial nerve injury after CEA was 9.2% (95% CI, 3.7%-21.1%) vs none after CAS. Late outcome showed rates of CVAE favoring CEA (P ϭ .014). The rate of restenosis Ͻ50% was higher in patients treated with CAS compared with CEA (P Ͼ .003). Of the nine cranial nerve injuries identified after CEA, only one was permanent, with the remainder resolving within a few weeks of operation.Comment: The article questions the commonly held assumption that CAS is preferred for treatment of carotid stenosis over CEA in patients with previous cervical radiation. The main problem with this study is a high possibility of selection bias, with individuals with worse radiation injury being treated with CAS and those with less injury treated with CEA. The report therefore cannot indicate a preferred revascularization strategy in patients requiring treatment of carotid stenosis with previous cervical radiation. The rate of adverse events is relatively low in both groups; therefore, the choice of treatment with CAS or CEA for carotid stenosis in patients with previous cervical radiation remains an individual treatment decision based on physician judgment. Both forms of treatment can provide reasonable results in appropriate patients.

Recent advances in Takayasu's arteritis

“…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.…”

Takayasu arteritis in a child: A case report

“…Se utilizan además otros inmunosupresores ahorradores de corticoides como agentes citotóxicos (ciclofosfamida, metotrexato, azatioprina, (7,(31)(32)(33)(34) micofenolato) , y en casos de poca respuesta a los mismos: agentes biológicos como tocilizumab (anti- (35) IL 6) , Rituximab (anti CD20 expresado en la (36) superficie de linfocitos B) , anti-Factor de Necrosis Tumoral (FNT) como etanercept, infliximab, ( 3 4 , 3 7 , 3 8 ) a d a l i m u m a b . L o s p r o c e d i m i e n t o s cardiovasculares descriptos con más frecuencia son cirugía de injerto (bypass), angioplastia percutánea con balón, angioplastia y stents, recorte de aneurisma (7,(39)(40)(41) y revascularización, con diferentes resultados .…”

Tratamiento endovascular en arteritis de Takayasu. Presentación de un caso clínico

“…En la etapa aguda, el riesgo de reestenosis y lesiones vasculares es mayor (por la friabilidad del tejido). 14,15 El uso combinado de las herramientas diagnósticas tomografía, resonancia y PET ha mejorado la detección de las lesiones de forma precoz.…”