title: Endovascular revascularization for carotid artery occlusion in patients with Takayasu arteritis.
abstract: OBJECTIVE
  Type I Takayasu arteritis is a progressive inflammatory disease involving the aortic arch and its main branches. If untreated, patients may develop a variety of serious conditions ranging from hemiplegia to death. Whilst there is a relatively strong evidence base for the outcome of surgical techniques, few reports have focused on revascularization using an endovascular technique in patients with Takayasu arteritis.
  
  
  METHODS
  From May 2007 to March 2013, 11 consecutive patients with Takayasu arteritis presenting with severe cerebral ischemia symptoms caused by occlusive lesion in carotid artery underwent elective revascularization, 10 on the left carotid artery and 1 on the right. All patients received immunosuppressive treatment pre-and post-operation. Contraindications to open surgery included: ESR >40 mm/h; ipsilateral cerebral infarction of <2 weeks duration and sufficient poor health whereby the patient cannot tolerate general anesthesia. Quality of life was analyzed using the EQ-5D questionnaire before and after surgery.
  
  
  RESULTS
  Patients were followed for a mean of 31.6±27.4 months. Seven cases of total occlusion and 2 cases of severe stenosis were recanalized successfully and experienced clinical remission. Recanalization failed in 2 patients, both of whom had occlusion of a long segment of the artery. Initial endovascularization comprised small diameter, low pressure dilatation only to allow time for the reopened arteries to respond. If clinically indicated, repeat angioplasty with a larger diameter balloon was performed 1-3 months later. Major complications occurred in 2 patients. Eight of the recanalized carotid arteries were patent at the end of follow-up and patients had satisfactory quality of life
  
  
  CONCLUSIONS
  In patients with Takayasu arteritis, carotid artery recanalization via endovascular surgery combined with immunosuppressive therapy is effective and can be performed safely and repeatedly. The improvement in carotid artery blood flow supplying the central nervous system relieves symptoms of cerebral ischemia and is associated with an improved quality of life.
authors.affiliation: Department of Vascular Surgery, The Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China; Department of Vascular Surgery, Xuan Wu Hospital, Capital Medical University, Beijing, China. Electronic address: Chenbing@chinamedicalnews.net.
authors.forename: B
authors.initials: B
authors.lastname: Chen
authors.affiliation: Department of Vascular Surgery, Xuan Wu Hospital, Capital Medical University, Beijing, China.
authors.forename: H X
authors.initials: HX
authors.lastname: Yu
authors.affiliation: Department of Vascular Surgery, Xuan Wu Hospital, Capital Medical University, Beijing, China.
authors.forename: J
authors.initials: J
authors.lastname: Zhang
authors.affiliation: Department of Immunology, Xuan Wu Hospital, Capital Medical University, Beijing, China.
authors.forename: X X
authors.initials: XX
authors.lastname: Li
authors.affiliation: Department of Evidence based Medicine, Xuan Wu Hospital, Capital Medical University, Beijing, China.
authors.forename: X G
authors.initials: XG
authors.lastname: Wu
authors.affiliation: Department of Vascular Surgery, Xuan Wu Hospital, Capital Medical University, Beijing, China.
authors.forename: S J
authors.initials: SJ
authors.lastname: Yang
authors.affiliation: Department of Vascular Surgery, Xuan Wu Hospital, Capital Medical University, Beijing, China.
authors.forename: Y X
authors.initials: YX
authors.lastname: Qi
authors.affiliation: Department of Vascular Surgery, Xuan Wu Hospital, Capital Medical University, Beijing, China.
authors.forename: C
authors.initials: C
authors.lastname: Yan
authors.affiliation: Department of Vascular Surgery, Xuan Wu Hospital, Capital Medical University, Beijing, China.
authors.forename: Z G
authors.initials: ZG
authors.lastname: Wang
mesh_terms: D000293:Adolescent; D000328:Adult; D001157:Arterial Occlusive Diseases / Q000150:complications / Q000601:surgery*; D002545:Brain Ischemia / Q000601:surgery*; D017536:Carotid Artery, Common / Q000601:surgery*; D002648:Child; D057510:Endovascular Procedures / Q000379:methods; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D011788:Quality of Life; D013625:Takayasu Arteritis / Q000150:complications / Q000601:surgery*; D016896:Treatment Outcome; D055815:Young Adult
keywords: Carotid artery; Cerebral ischemia; Endovascular surgery; Quality of life; Recanalization; Takayasu arteritis