Endovascular Treatment of Intracerebral Giant Cell Arteritis

Simonsen, Claus Z; Speiser, Lasse; Hansen, Ib Tønder; Jayne, David; Weitzel-Mudersbach, Paul von

doi:10.3389/fneur.2020.00287

Cited by 12 publications

(11 citation statements)

References 15 publications

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“…Endovascular balloon dilatation of the stenotic areas has been attempted in GCA patients with involvement of the cerebral vessels causing stroke where aggressive immunosuppression was unsuccessful. 187,188…”

Section: Endovascular Treatmentmentioning

confidence: 99%

Diagnosis and management of giant cell arteritis: Major review

Simon

Ninan

Hissaria

2021

Clinical Exper Ophthalmology

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Giant cell arteritis is a medical emergency because of the high risk of irreversible blindness and cerebrovascular accidents. While elevated inflammatory markers, temporal artery biopsy and modern imaging modalities are useful diagnostic aids, thorough history taking and clinical acumen still remain key elements in establishing a timely diagnosis. Glucocorticoids are the cornerstone of treatment but are associated with high relapse rates and side effects. Targeted biologic agents may open up new treatment approaches in the future.

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Section: Endovascular Treatmentmentioning

confidence: 99%

Diagnosis and management of giant cell arteritis: Major review

Simon

Ninan

Hissaria

2021

Clinical Exper Ophthalmology

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“…Initial query of the databases identified 55 studies after duplicates were removed. Of these, nine studies were included in the analysis [ 20 – 28 ] after excluding cases in which GCA was not the diagnosis or the endovascular treatment did not involve intracranial vessels. The demographic, clinical, and technical details of each study are shown in Table 2 .…”

Section: Resultsmentioning

confidence: 99%

“…of Treatments Technique Target Vessel CV Risk Factors ESR CRP Corticosteroid treatment a Adjuvant Immunosuppressant a Vascular medications a Complications Clinical outcome b Clinical follow-up (days) 1 Simonsen et al. 2020 [ 20 ] 1 65F 2 PTA LICA None 46 NR Prednisone 1 mg/kg → solumedrol → prednisone taper CPM 15 mg/kg → tocilizumab → oral CPM × 6 mo, then methotrexate NR 1 MRS 2 90 2 64F 3 PTA LICAx3, RICAx2 HTN, DM 57 NR Prednisone 1 mg/kg → solumedrol → CPM 15 mg/kg × 6 → methotrexate NR Dissection x1, PCP pneumonia MRS 3 90 3 72M 2 PTA LICAx3, RICAx1, LVx1 HTN, smoking 22 NR Prednisone taper 1 mg/kg → solumedrol → prednisone taper CPM 10 mg/kg × 6 NR 0 MRS 1 90 4 71F 2 PTA LICAx2, RICAx2, LVx1 HTN 54 NR Solumedrol 1 mg/d → CPM 15 mg/kg × 6 NR Dissection x1 MRS 4 90 2 Lago et al. 2020 [ 21 ] 5 72F 1 PTA LICA HTN 50 NR Prednisone, ‘megadose’steroids dose NR None ASA during hospitalizat...…”

Section: Resultsmentioning

confidence: 99%

Endovascular Therapy for Intracranial Giant Cell Arteritis

et al. 2022

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Background Giant cell arteritis (GCA) is a systemic vasculitis that may cause ischemic stroke. Rarely, GCA can present with aggressive intracranial stenoses, which are refractory to medical therapy. Endovascular treatment (EVT) is a possible rescue strategy to prevent ischemic complications in intracranial GCA but the safety and efficacy of EVT in this setting are not well-described. Methods A systematic literature review was performed to identify case reports and series with individual patient-level data describing EVT for intracranial GCA. The clinical course, therapeutic considerations, and technique of seven endovascular treatments in a single patient from the authors’ experience are presented. Results The literature review identified 9 reports of 19 treatments, including percutaneous transluminal angioplasty (PTA) with or without stenting, in 14 patients (mean age 69.6 ± 6.3 years). Out of 12 patients 8 (66.7%) with sufficient data had > 1 pre-existing cardiovascular risk factor. All patients had infarction on MRI while on glucocorticoids and 7/14 (50%) progressed despite adjuvant immunosuppressive agents. Treatment was PTA alone in 15/19 (78.9%) cases and PTA + stent in 4/19 (21.1%). Repeat treatments were performed in 4/14 (28.6%) of patients (PTA-only). Non-flow limiting dissection was reported in 2/19 (10.5%) of treatments. The indications, technical details, and results of PTA are discussed in a single illustrative case. We report the novel use of intra-arterial calcium channel blocker infusion (verapamil) as adjuvant to PTA and as monotherapy, resulting in immediate improvement in cerebral blood flow. Conclusion Endovascular treatment, including PTA with or without stenting or calcium channel blocker infusion, may be effective therapies in medically refractory GCA with intracranial stenosis.

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“…In contrast, previous studies report successful endovascular treatment in patients with progressive intracranial stenosis in GCA. [28][29][30][31][32] However, reports of endovascular intervention with favorable results are more likely to be published than failed attempts. On the other side, these data must be judged considering the retrospective study design.…”

Section: Discussionmentioning

confidence: 99%

Characterization of Extracranial Giant Cell Arteritis with Intracranial Involvement and its Rapidly Progressive Subtype

Beuker

Wankner

Thomas

et al. 2021

Annals of Neurology

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The objective of this study was to characterize patients with extracranial giant cell arteritis with intracranial involvement. Methods: In a multicenter retrospective study, we included 31 patients with systemic giant cell arteritis (GCA) with intracranial involvement. Clinical characteristics, pattern of arterial involvement, and cytokine profiles were assessed. Patients with GCA without intracranial involvement (n = 17), and with intracranial atherosclerosis (n = 25) served as controls. Results: Erythrocyte sedimentation rate (ESR) was elevated in 18 patients (69.2%) with and in 16 patients (100%) without intracranial involvement (p = 0.02). Headache was complained by 15 patients (50.0%) with and 13 patients (76.5%) without intracranial involvement (p = 0.03). Posterior circulation arteries were affected in 26 patients (83.9%), anterior circulation arteries in 17 patients (54.8%), and both territories in 12 patients (38.7%). Patients with GCA had vertebral artery stenosis proximal and, in contrast, patients with atherosclerosis distal to the origin of posterior inferior cerebellar artery (PICA). Among patients with GCA with intracranial involvement, 11 patients (37.9%) had a rapid progressive disease course characterized by short-term recurrent ischemic events. The median modified Rankin Scale (mRS) at followup in these patients was 4 (interquartile range [IQR] = 2.0-6.0) and 4 patients (36.4%) died. Vessel wall expression of IL-6 and IL-17 was significantly increased in patients with rapid progressive course. Interpretation: Typical characteristics of GCA, headache, and an elevated ESR, are frequently absent in patients with intracranial involvement. However, differentiation of intracranial GCA from atherosclerosis can be facilitated by the typical pattern of vertebral artery stenosis. About one-third of patients with intracranial GCA had a rapid progressive course with poor outcome. IL-17 and IL-6 may represent potential future treatment targets.

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Endovascular Treatment of Intracerebral Giant Cell Arteritis

Cited by 12 publications

References 15 publications

Diagnosis and management of giant cell arteritis: Major review

Diagnosis and management of giant cell arteritis: Major review

Endovascular Therapy for Intracranial Giant Cell Arteritis

Characterization of Extracranial Giant Cell Arteritis with Intracranial Involvement and its Rapidly Progressive Subtype

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