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 Affiliated Hospital of Zhejiang University, the Second Medical College of Beijing University, Beijing An Zhen Hospital, and the Beijing Union Medical College Hospital, including 10 men and 83 women, were reviewed. Of the 93 cases, bypasses from the ascending aorta to the axillary or subclavian artery and from graft to the 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 recurrence requiring revision in 8.2%.


CONCLUSIONS
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 feasible in most instances, and this can and should be done when the cerebral perfusion 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.
Wang
Zhonggao
Z
Vascular Institute, General Post & Telecom Hospital, the Eighth Clinical College of Beijing University, Beijing 100032, China. zhonggaowang@yahoo.com
Shen
Laigen
L
Yu
Jun
J
Gu
Yongquan
Y
Wang
Shihua
S
Guan
Heng
H
Wu
Qinghua
Q
Zhang
Xiaoming
X
Li
Ming
M
Wu
Jidong
J
Li
Guoxing
G
Pan
Songlin
S
Zhang
Hongkun
H
Jin
Wei
W
D000293:Adolescent; D000328:Adult; D000800:Angioplasty, Balloon; D002545:Brain Ischemia / Q000209:etiology* / Q000601:surgery / Q000628:therapy; D002648:Child; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D008517:Phytotherapy; D028321:Plant Preparations / Q000627:therapeutic use; D013625:Takayasu Arteritis / Q000150:complications*; D029757:Tripterygium
D028321:Plant Preparations