Management of cerebral ischemia due to Takayasu''''s arteritis

Ａｏｒｔｏａｒｔｅｒｉｔｉｓ ,ａｌｓｏｃａｌｌｅｄＴａｋａｙａｓｕ’ｓａｒｔｅｒｉｔｉｓ ,ｉｓａｃｈｒｏｎｉｃｉｄｉｏｐａｔｈｉｃｉｎｆｌａｍｍａｔｏｒｙｄｉｓｅａｓｅｔｈａｔａｆｆｅｃｔｓｌａｒｇｅａｎｄｍｅｄｉｕｍｓｉｚｅａｒｔｅｒｉｅｓ Ｃｌｉｎｉｃａｌｆｅａｔｕｒｅｓｒｅｆｌｅｃｔｌｉｍｂｏｒｏｒｇａｎｉｓｃｈｅｍｉａｒｅｓｕｌｔｉｎｇｆｒｏｍｓｔｅｎｏｓｉｓｔｏｏｂｌｉｔｅｒａｔｉｏｎｏｆｉｎｖｏｌｖｅｄａｒｔｅｒｉｅｓ Ｔｈｉｓｄｉｓｅａｓｅ ,ｄｅｓｃｒｉｂｅｄｂｙＴａｋａｙａｓｕｉｎ…

Management of cerebral ischemia due to Takayasu''''s arteritis

Objective To explore the management of cerebral ischemia caused by Takayasu's arteritis. Methods Ninety-three cases treated from June 1984 to September 1999 at the General Post & Telecom Hospital, the Sir Run Run Shaw Hospital, the First Af filiated Hospital of Zhejiang University, the Second Medical College of Beijing University, Beijing An Zhen Hospital, and the Beijing Union Medical College Hosp ital, including 10 men and 83 women, were reviewed. Of the 93 cases, bypasses f rom the ascending aorta to the axillary or subclavian artery and from graft to t he carotid artery were performed in 47 cases. Subclavian to carotid bypass was performed in six cases. Percutaneous transluminal angioplasty (PTA) was used in five cases and stenting in one. Results Marked improvement was achieved in 30.3%, fair in 34.9%, improvement in 21.2 %, unchanged in 4.6%, and death in 9.0% before discharge; 30.6%, 38.8%, 16 .3%, 4.1%, and 2.0% respectively during a mean follow-up of 48 months, and r ecurrence requiring revision in 8.2%. Conclusion Patients with occlusive lesions of all four cervical arteries always have severe cerebral ischemia and their distal runoff is always unvisualised by angiography . However, we found by exploration that the internal carotid artery is patent in all but one patient. Therefore, an ascending aorta to carotid bypass is feasib le in most instances, and this can and should be done when the cerebral perfusio n is jeopardized at a time when the patient is in a stable or relatively stable condition. Unfortunately, the cerebral re-perfusion syndrome is still a serious and not completely solved problem.