[Challenges in management of cerebral ischemia due to Takayasu's arteritis].
OBJECTIVE
To explore the management of cerebral ischemia caused by Takayasu's arteritis.


METHODS
One hundred and three cases treated from 1984 to 2003 were reviewed including 92 females. Seven cases underwent ascending aorta to bilateral internal carotid artery (ICA) bypass, 38 cases to the axillary artery with graft to single ICA bypass. Six cases underwent ascending aorta to axillary bypass with 3 graft to single ICA bypasses as the second stage surgery. Three cases underwent ascending aorta to right ICA bypass with 2 graft to left ICA bypasses as well as 6 subclavian to carotid bypass, PTA in 5 and stenting in 3 cases, etc.


RESULTS
Twenty-seven patients with less clinical severity received conservative therapy, 9 of them had mostly temporarily improvement, 15 had slight improvement or basically no change, 1 had hemiplegia and 2 died of stroke and myocardial infarction respectively. Surgically, the short-term effective rate was 87% and operative death 7.8%. Fifty-five patients were followed up, a mean follow-up time was 48 months, and the follow-up rate was 80.9%. The excellently, good, fair, no change and death rate were 36.4%, 38.2%, 20.0%, 3.6% and 1.8% respectively. All patients with PTA or stent had an immediate good response and all recurred within 3 to 5 months.


CONCLUSIONS
For treating severe cerebral ischemia caused by Takayasu's arteritis, the ascending aorta to axillary and single ICA reconstruction or the ascending aorta-bilateral axillary bypass for patients with subclavian steal syndrome is advocated; second stage operation from graft to contralateral ICA can be carried out if necessary.
Wang
Zhong-gao
ZG
Vascular Institute, Xuanwu Hospital, Capital University of Medical Sciences, Beijing 100053, China.
Gu
Yong-quan
YQ
Zhang
Jian
J
Li
Jian-xin
JX
Yu
Heng-xi
HX
Luo
Tao
T
Guo
Lian-rui
LR
Chen
Bing
B
Li
Xue-feng
XF
Qi
Li-xing
LX
D000293:Adolescent; D000328:Adult; D000800:Angioplasty, Balloon; D002545:Brain Ischemia / Q000209:etiology / Q000628:therapy*; D002343:Carotid Artery, Internal / Q000601:surgery; D002548:Cerebral Revascularization / Q000379:methods*; D002648:Child; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D015607:Stents; D013625:Takayasu Arteritis / Q000150:complications*; D016896:Treatment Outcome; D014656:Vascular Surgical Procedures