Giant cell arteritis with vertebral artery involvement—baseline characteristics and follow-up of a monocentric patient cohort

Prünte, Mona Klara Ros; Naumann, Anne; Christ, Monika; Naumann, Markus; Bayas, Antonios

doi:10.3389/fneur.2023.1188073

Cited by 4 publications

(9 citation statements)

References 41 publications

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“…Stroke recurrence may occur after treatment initiation although stenotic lesions apparently improve on control exams (193), raising the question of a focal low-grade relapse or unrelated cause. Early initiation of drugs (including cyclophosphamide or TCZ) failed to suppress stroke recurrence (87,136), reinforcing the hypothesis that GCA relapses do not completely account for ischemic relapses. .…”

Section: Improbable Stroke Mechanisms and Brain Vessel Complications ...mentioning

confidence: 60%

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Giant-cell arteritis related strokes: scoping review of mechanisms and rethinking treatment strategy?

Bonnan,

Debeugny

2023

Front. Neurol.

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Stroke is a rare and severe complication of giant cell arteritis (GCA). Although early diagnosis and treatment initiation are essential, the mechanism of stroke is often related to vasculitis complicated by arterial stenosis and occlusion. Its recurrence is often attributed to early steroid resistance or late GCA relapse, so immunosuppressive treatment is often reinforced. However, many questions concerning the mechanisms of stroke remain elusive, and no review to date has examined the whole data set concerning GCA-related stroke. We therefore undertook this scoping review. GCA-related stroke does not necessarily display general signs and inflammatory parameters are sometimes normal, so clinicians should observe caution. Ischemic lesions often show patterns predating watershed areas and are associated with stenosis or thrombosis of the respective arteries, which are often bilateral. Lesions predominate in the siphon in the internal carotid arteries, whereas all the vertebral arteries may be involved with a predominance in the V3-V4 segments. Ultrasonography of the cervical arteries may reveal edema of the intima (halo sign), which is highly sensitive and specific of GCA, and precedes stenosis. The brain arteries are spared although very proximal arteritis may rarely occur, if the patient has microstructural anatomical variants. Temporal artery biopsy reveals the combination of mechanisms leading to slit-like stenosis, which involves granulomatous inflammation and intimal hyperplasia. The lumen is sometimes occluded by thrombi (<15%), suggesting that embolic lesions may also occur, although imaging studies have not provided strong evidence for this. Moreover, persistence of intimal hyperplasia might explain persisting arterial stenosis, which may account for delayed stroke occurring in watershed areas. Other possible mechanisms of stroke are also discussed. Overall, GCA-related stroke mainly involves hemodynamic mechanisms. Besides early diagnosis and treatment initiation, future studies could seek to establish specific preventive or curative treatments using angioplasty or targeting intimal proliferation.

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Section: Improbable Stroke Mechanisms and Brain Vessel Complications ...mentioning

confidence: 60%

“…a) no patient developed early stroke in the GiACTA trial, so the preventive effect against stroke could not be compared with the effect of steroids (only one stroke and visual loss occurred at day 254) ( 135 ), whereas in an observational study, 40% (2 of 5) of TCZ-treated patients ( 136 );…”

Section: Resultsmentioning

confidence: 99%

Giant-cell arteritis related strokes: scoping review of mechanisms and rethinking treatment strategy?

Bonnan,

Debeugny

2023

Front. Neurol.

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“…Complications in the nervous system, mainly ischemic stroke, are mostly due to the involvement of the extradural vertebral arteries, rather than carotid and intracranial vasculitis (2,(4)(5)(6). In more than half of the cases, strokes are attributable to GCA as a result of vertebrobasilar system involvement (7). Vertebral artery (VA) involvement, which causes neurological deficits in the brainstem and/ or cerebellum, results in high mortality if not diagnosed and treated in time (2,7).…”

Section: Introductionmentioning

confidence: 99%

“…In more than half of the cases, strokes are attributable to GCA as a result of vertebrobasilar system involvement (7). Vertebral artery (VA) involvement, which causes neurological deficits in the brainstem and/ or cerebellum, results in high mortality if not diagnosed and treated in time (2,7). In contrast, documented involvement of intracranial vessels in GCA is very rare (7).…”

Section: Introductionmentioning

confidence: 99%

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Increased vertebral canal diameter measured by ultrasonography as a sign of vasculitis in patients with giant cell arteritis

Ayo-Martin,

Garcia-Garcia,

Hernandez-Fernandez

et al. 2023

Front. Med.

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IntroductionThe diagnosis of giant cell arteritis (GCA) by ultrasonography including large vessels, apart from the temporal artery increases the sensibility of the study and informs about the risk of specific complications. However, there is less information about the study of these arteries, whose affection carries higher proportion of severe complications.ObjectivesTo describe and analyze the value of the diameter of the cervical vertebral canal of the vertebral artery (VA) as a sign of vertebral vasculitis (VV) related to GCA and estimate the risk of stroke complications.Materials and methodsObservational study of a population that includes patients with GCA with and without VA vasculitis as well as healthy subjects. We evaluated whether there were differences in VA diameter in the groups and, if so, we estimated the diagnostic capacity of the variable that best defines VA diameter using a ROC curve. Cut-off points with their associated reliability chosen thereafter.ResultsThere were 347 subjects included:107 with GCA of whom 37 had vertebral vasculitis, 240 healthy controls. In patients with GCA and VV, the VA diameter was increased (No GCA 3.4 mm, GCA without VV 3.6 mm, GCA with VV 5.2 mm p < 0.01). According to the ROC curves, the variable defining vertebral diameter with best diagnostic accuracy is the sum of both sides (area under the curve of 0.98). With a cut-off point of 8.45 mm, the reliability values are: sensitivity 94.1%, specificity 94.5%, PPV 82.1% and NPV 98.4%. With a cut-off point of 9.95 mm, the sensitivity is 52.9% and the specificity is 100%. Likewise, VA diameter is independently associated with the presence of stroke in the vertebrobasilar territory (OR 1.6, range 1.2–2.2).ConclusionThe VA diameter, measured as the sum of both sides, is an objectively measurable sign with very high reliability for detect vertebral vasculitis in patients with GCA. It is proposed here as a novel echographic sign, which can aid the detection of the involvement of an artery where the complications are especially serious.

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Intrinsic stenosing and occlusive pathologies of the vertebral artery: A narrative review

Correia,

Meyer,

Odier

2024

Neurochirurgie

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Giant cell arteritis with vertebral artery involvement—baseline characteristics and follow-up of a monocentric patient cohort

Cited by 4 publications

References 41 publications

Giant-cell arteritis related strokes: scoping review of mechanisms and rethinking treatment strategy?

Giant-cell arteritis related strokes: scoping review of mechanisms and rethinking treatment strategy?

Increased vertebral canal diameter measured by ultrasonography as a sign of vasculitis in patients with giant cell arteritis

Intrinsic stenosing and occlusive pathologies of the vertebral artery: A narrative review

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