Transient perivascular inflammation of the carotid artery (TIPIC) syndrome

Abstract

Summary: Background: The Transient Perivascular Inflammation of the Carotid artery (TIPIC) syndrome is presumably a very rare disease characterized by a local transient inflammation of the tissue around the carotid artery. Its pathophysiology remains unknown. We performed an updated study of TIPIC syndrome cases in the setting of a multinational collaborative study. Methods: This study was conducted as an observational multinational retrospective individual patient level cohort study. Information from all known cases diagnosed with TIPIC syndrome in the literature (2005–2020) was collected after a semi-structured literature search of PubMed and Web of Science. We also collected unpublished information of patients from French, Swiss, and Italian vascular medicine or radiology departments. Results: A total of 72 patients were included and served for data analysis: 42 (58.3%) were women; the mean age was 47.9 (SD=11.4) years. Symptoms were unilateral in 92% of patients and 81.4% required pain killers. At baseline, irrespective of the imaging method used, the median thickness of the carotid lesions was 5 (Q1–Q3: 4–7; range: 2–11) mm and the median length of the lesion was 20 (Q1–Q3: 10–30; range: 3–50) mm. We found a positive linear correlation between thickness and length. At follow-up, the thickness of the carotid lesions decreased to a median of 2 (Q1–Q3: 1–3; range: 0–6) mm; the length decreased to a median 10 (Q1–Q3: 5–15; range: 0–41) mm. A linear correlation between baseline and follow-up values was observed for both thickness and length measurements. Symptoms disappeared after a median of 14 (Q1–Q3: 10–15) days. Thirteen patients experienced a recurrence after a median follow-up of 6 (Q1–Q3: 2–12) months. Conclusions: The present analysis elucidates clinical and sonographic characteristics of TIPIC syndrome, indicating the benign nature of this condition. A future international registry will study the long-term course of the disease.

Vaskulitis mimics

“…Beim TIPIC Syndrom besteht neben akuten, meist einseitigen Schmerzen im Halsbereich bildmorphologisch eine exzentrische perivaskuläre Infiltration der Arteria carotis (▶ abb. 2) [23,24]. Die Diagnose setzt den Ausschluss einer anderen vaskulären oder nichtvaskulären Ursache voraus.…”

“…Die Diagnose setzt den Ausschluss einer anderen vaskulären oder nichtvaskulären Ursache voraus. In Fallserien kommt es innerhalb von 14 Tagen meist zu einer deutlichen Besserung, spontan oder unter Therapie mit Acetylsalicylsäure oder anderen Analgetika mit antiphlogistischer Wirkung [23,24]. Es muss erwähnt werden, dass einzelne Patienten in einer Fallserie [23] Glukokortikoide erhielten oder unter einer Autoimmunerkrankungen litten, die zeitgleich mit dem Auftreten des TIPIC-Syndroms, exazerbiert war.…”

“…Die Auffälligkeiten in der Bildgebung sind schnell reversibel. Daher könnte bei Patienten mit akuten Beschwerden, in denen keine kurzfristige sonographische Untersuchung durchgeführt wird, eine erhebliche Unterdiagnose wahrscheinlich sein [24].…”

Retrospective analysis of long-term clinical, diagnostic and outcome parameters in patients with TIPIC syndrome

“…Intermittent slightly elevated C-reactive protein and erythrocyte sedimentation rate were observed up to 1 Although the present study is limited by a small sample size, demographic and clinical findings of our case series are comparable to other recent studies, but with some differences, such as higher rates of preexisting autoimmune disorders, cardiovascular risk factors, posttraumatic events, or local neck swelling. 1,2,4 Additionally, all of our investigated patients had hypercholesterolemia at disease onset. Those findings may support (auto-) inflammatory but also atherosclerotic implications in the development of TIPIC syndrome, as previously reported.…”

G‐CSF‐induced TIPIC syndrome and large vessel vasculitis: A case report

“…A recent multicenter retrospective study of 72 patients with TIPIC syndrome confirmed the benign nature of this disorder and that recurrence may occur in up to 20% of cases. 3 However, TIPIC pathophysiology and triggers remain poorly understood.…”