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Percutaneous Intervention in Patients With Takayasu Arteritis
Quick Takes
- Data from this extensive series of patients with Takayasu arteritis (TAK) undergoing percutaneous interventions (PIs) demonstrate that most significant vascular lesions encountered in TAK can be safely and effectively treated with PI.
- The PI-related complication rate was 17%. Although restenosis rates were high, repeat interventions yielded durable results with minimal risk.
Study Questions:
What are success rates for percutaneous interventions (PIs) among patients with Takayasu arteritis (TAK) and symptomatic vascular lesions?
Methods:
A prospectively maintained single-center database of TAK PI procedures from 1996–2022 was analyzed retrospectively. Obstructive lesions were treated by elective stenting (using bare or covered stents), balloon angioplasty (BA), or cutting-balloon angioplasty (CBA), with adjunctive stenting for suboptimal BA/CBA results. PIs were repeated in restenotic lesions until sustained success was obtained. Aortic/peripheral aneurysms and spontaneous aortic dissections received covered stents or endografts. Immunosuppressive therapy, started prior to PI, was continued long-term.
Results:
A total of 942 patients underwent PI to treat 2,450 arterial lesions (2,365 stenosis/occlusion, 85 aneurysm/dissection) in 630 subclavian/axillary, 586 renal, 463 aortic, 333 carotid, 188 mesenteric, 116 iliac, 71 coronary, and 63 other arteries; 3,805 PIs were performed (1.55 PIs/lesion, range 1-7). Early success was obtained in 2,262 (92.3%), and late success in 1,460 (84.5%) of 1,727 lesions with a median 39 (interquartile range, 15-85) months of follow-up. Repeated PIs increased late success in obstructive lesions from 48.6% to 83.3%. A total of 1,687 elective stenting lesions achieved 88% late success with 1.49 PIs/lesion; covered stents (1.18 PIs/lesion) restenosed less than bare stents (1.51 PIs/lesion, p < 0.001). A total of 183 (36%) of 513 BA-treated lesions had good outcomes without adjunctive stenting; 122 CBA-treated lesions had 19% dissection and 8% rupture/pseudoaneurysm formation. Aneurysms/dissections had 91.3% late success after PI. A total of 472 complications occurred in 415 (17%) lesions; 375 (79%) were resolved.
Conclusions:
Most vascular lesions in TAK can be effectively, safely, and durably treated using predominantly stent-based PI strategies.
Perspective:
Data from this large (n = 942; 2,450 lesions), retrospective, single-center registry aimed to define strategies for PI in multiple vascular beds (630 subclavian/axillary, 586 renal, 463 aortic, 333 carotid, 188 mesenteric, 116 iliac, 71 coronary, and 63 other arteries) among patients with TAK. The PI-related complication rate was 17%. Although restenosis rates were high, repeat interventions yielded durable results with minimal risk. Findings support more liberal use of and provide a framework for PIs among TAK patients.
Clinical Topics: Invasive Cardiovascular Angiography and Intervention, Vascular Medicine, Interventions and Vascular Medicine
Keywords: Aneurysm, Angioplasty, Balloon, Aneurysm, Dissecting, Coronary Occlusion, Coronary Stenosis, Dissection, Percutaneous Coronary Intervention, Stents, Takayasu Arteritis, Vascular Diseases
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