Surgical Treatment for Cerebrovascular Disease in Takayasu's Arteritis

ABSTRACT

PURPOSE: Takayasu's arteritis is a chronic disease characterized by nonspecific inflammation of the aorta and its branches, and cerebral ischemia has been considered to be the most life-threatening complication of this disorder. METHOD: We performed a retrospective review of 13 patients who underwent 16 procedures between 1996 and 2006 secondary to cerebrovascular symptoms in Takayasu's arteritis (median follow-up=52.5 months). RESULT: Study subjects included 10 females and 3 males, with a median age of 36.5 years. Procedures included 7 bypasses (2 aorto-bicarotid artery, 1 axillo-axillary artery, 2 subclavian-common carotid artery, 1 common carotid-internal carotid artery, and 1 axillo-vertebral artery), 4 carotid endarterectomies (CEA), and 5 stents (4 common carotid artery [1 for the treatment of re-stenosis of CEA] and 1 vertebral artery). All patients were relieved of their cerebral ischemic symptoms and remained stroke-free during the follow-up period. Re-stenosis was seen in two cases of stenting. Occlusion or stenosis of arterial reconstruction occurred more frequently in patients who had elevated erythrocyte sedimentation rates (ESR) preoperatively (P<0.05). CONCLUSION: Surgical treatment was effective in stroke prevention and elimination of cerebrovascular symptoms. The patency of the reconstruction was related to the progression of the disease as indicated by elevated ESR and [18F]fluorodeoxyglucose positron emission tomography, which are useful tools for evaluating disease activity.