Open and Endovascular Management of Severe Cerebral Ischemia in Takayasu's Arteritis

Luo, Xiao Yun; Wu, Qing; Zhang, Fu Xian

doi:10.1016/j.avsg.2017.01.001

Cited by 14 publications

(8 citation statements)

References 26 publications

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“…Evidence supporting the surgical management of arterial stenosis in TAK arises from several retrospective case series (LoE 4), with variable baseline characteristics of the patients included, different involved vascular sites and variable concomitant medical treatment 76–108. Indications for referral, when specified, mainly comprised symptomatic arterial stenosis (eg, renovascular uncontrolled hypertension, transient ischaemic attack, limb claudication, syncope, vertigo, angina).…”

Section: Resultsmentioning

confidence: 99%

Management of Takayasu arteritis: a systematic literature review informing the 2018 update of the EULAR recommendation for the management of large vessel vasculitis

et al. 2019

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ObjectiveTo collect available evidence on management of large vessel vasculitis to inform the 2018 update of the EULAR management recommendations.MethodsTwo independent systematic literature reviews were performed, one on diagnosis and monitoring and the other on drugs and surgical treatments. Using a predefined PICO (population, intervention, comparator and outcome) strategy, Medline, Embase and Cochrane databases were accessed. Eligible papers were reviewed and results condensed into a summary of findings table. This paper reports the main results for Takayasu arteritis (TAK).ResultsA total of 287 articles were selected. Relevant heterogeneity precluded meta-analysis. Males appear to have more complications than females. The presence of major complications, older age, a progressive disease course and a weaker inflammatory response are associated with a more unfavourable prognosis. Evidence for details on the best disease monitoring scheme was not found. High-quality evidence to guide the treatment of TAK was not found. Glucocorticoids are widely accepted as first-line treatment. Conventional immunosuppressive drugs and tumour necrosis factor inhibitors were beneficial in case series and uncontrolled studies. Tocilizumab failed the primary endpoint (time to relapse) in a randomised controlled clinical trial; however, results still favoured tocilizumab over placebo. Vascular procedures may be required, and outcome is better when performed during inactive disease.ConclusionsEvidence to guide monitoring and treatment of patients with TAK is predominantly derived from observational studies with low level of evidence. Therefore, higher-quality studies are needed in the future.

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Section: Resultsmentioning

confidence: 99%

Management of Takayasu arteritis: a systematic literature review informing the 2018 update of the EULAR recommendation for the management of large vessel vasculitis

et al. 2019

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“…Endovascular approaches are often complicated by long occluded segments and this approach is typically reserved for those with short focal lesions or for those patients considered to be too high risk for open surgery (44). Long-term patency rates are in the range of 50-75% at 3-5 years respectively (41,45). The risk of cerebral hyperperfusion ± haemorrhage can be reduced by tight pre-operative blood pressure control and the use of unilateral as opposed to bilateral aorto-carotid bypass (41,43).…”

Section: Supra-aortic Disease and Cerebral Ischemiamentioning

confidence: 99%

Surgical intervention and its role in Takayasu arteritis

Mason

2018

Best Practice & Research Clinical Rheumatology

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Vascular surgery remains an important option in the management of Takayasu arteritis. Its use is predominantly confined the treatment of symptomatic organ ischaemia or life-threatening aneurysm formation. In most cases this follows the failure of medical therapy to prevent arterial injury. Open surgery and endovascular approaches are used. The choice between them, at least in part, is determined by the site and nature of the lesion. Although more invasive, open surgery offers enhanced duration of arterial patency. For endovascular intervention, primary angioplasty without stenting is preferred, with stenting reserved for primary or secondary angioplasty failures. Although there is increasing interest in the role of stent grafts and tailor-made endovascular stents, long-term outcomes remain to be reported. Interventional outcomes are improved and complications reduced by therapeutic control of disease activity pre-and post-surgery. The wider use of combined immunosuppression and the introduction of biologic therapy for refractory Takayasu arteritis may reduce future requirements for surgical intervention.

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“…Year Selection Comparability Outcome Total score Wang et al 29 2017 ++++ + ++ 7 Yang et al 30 2017 ++++ +++ 7 Luo et al 4 2017 ++++ + ++ 7 Xiao et al 6 2016 ++++ + ++ 7 Diao et al 19 2016 ++++ ++ 6 Labarca et al 18 2016 ++++ + +++ 8 Kinjo and Kafa 20 2015 ++++ +++ 7 Perera et al 8 2014 ++++ +++ 7 Lee et al 21 2014 ++++ +++ 7 Kim et al 31 2012 ++++ + +++ 8 Kim et al 22 2013 ++++ ++ 6 Saadoun et al 1 2012 ++++ + +++ 8 Ham et al 23 2011 ++++ + ++ 7 Cong et al 24 2010 ++++ ++ 6 Maksimowicz-McKinnon et al 32 2007 ++++ +++ 7 Kalangos et al 25 2006 +++ + +++ 7 Liang et al 26 2004 ++++ ++ 6 Kumar et al 27 2003 ++++ ++ 6 Stoodley et al 28 2000…”

Section: Studyunclassified

“…Surgical treatment includes the following: (i) endovascular intervention, including percutaneous transluminal angioplasty (PTA), stent insertion, and stent graft placement; and (ii) open surgical intervention, including surgical bypass grafting, patch angioplasty for short segment lesions, and endarterectomy. 3 Open surgical intervention is sometimes difficult because of multiple lesions or poor general condition, 4 and may cause complications, such as post-operative bleeding, cerebrovascular accidents, and anastomotic aneurysm. 5e7 In contrast, endovascular intervention is relatively safe and has shown favourable short term results.…”

Section: Introductionmentioning

confidence: 99%

Endovascular Versus Open Surgical Intervention in Patients with Takayasu's Arteritis: A Meta-analysis

Jung

Lee

Song

et al. 2018

European Journal of Vascular and Endovascular Surgery

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This meta-analysis has shown a lower risk of restenosis with open surgical intervention than with endovascular intervention. Stroke was generally more common with open surgical intervention than with endovascular intervention. However, there were differences according to the location of the lesion, and the risk of stroke in open surgery is higher when the supra-aortic branches are involved rather than the renal arteries.

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Open and Endovascular Management of Severe Cerebral Ischemia in Takayasu's Arteritis

Cited by 14 publications

References 26 publications

Management of Takayasu arteritis: a systematic literature review informing the 2018 update of the EULAR recommendation for the management of large vessel vasculitis

Management of Takayasu arteritis: a systematic literature review informing the 2018 update of the EULAR recommendation for the management of large vessel vasculitis

Surgical intervention and its role in Takayasu arteritis

Endovascular Versus Open Surgical Intervention in Patients with Takayasu's Arteritis: A Meta-analysis

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