Author + information
- George Joseph, MD, DM∗ ( and )
- Anoop Mathew, MD, DM
- ↵∗Reprint requests and correspondence:
Dr. George Joseph, Department of Cardiology, Christian Medical College, Vellore-632004, Tamil Nadu, India.
In Takayasu arteritis, obliteration of the vessel lumen by mural thrombus secondary to inflammatory changes in the vessel wall is common in the aortic arch branches; the thrombus gradually undergoes organization and becomes a fibrous mass within which multiple vascular channels develop. In some cases, these channels allow partial restoration of anterograde flow through the previously occluded artery segment (1). This phenomenon was seen angiographically in the common carotid arteries of a 43-year-old man who presented with dizziness, amaurosis fugax, and bilateral arm claudication. He met 5 of the 6 American College of Rheumatology criteria for diagnosis of Takayasu arteritis (2) and had normal levels of inflammatory markers indicating inactive disease. Both common carotid arteries exhibited diseased segments containing tangles of corkscrew channels located within the expected confines of the vessel wall (Figures 1A, 1C, and 1E⇓) with limited anterograde flow through them. The subclavian arteries had long-segment occlusions bilaterally, but these were solid occlusions without angiographic evidence of vascular channels within them. After obtaining informed consent, the diseased common carotid artery segments were traversed by fine manipulation of 0.014-inch steerable hydrophilic wires, after which balloon dilation and self-expanding stent deployment resulted in replacement of the multiple vascular channels by a single large channel with normal anterograde flow (Figures 1B and 1D). Interventions on the 2 sides were performed 6 months apart without cerebral protection and were uncomplicated; the subclavian artery occlusive lesions were concurrently recanalized and stented using standard technique. Follow-up angiography after 2 years (Figure 1F) showed widely patent carotid stents and minor subclavian in-stent restenosis; the patient was asymptomatic over this period. In Takayasu arteritis patients with inactive disease, arterial lesions with angiographic evidence of multiple vascular channels inside the expected limits of the vessel wall with limited anterograde flow are indicative of chronic fibrous, partially recanalized occlusions that are amenable to successful percutaneous intervention.
The authors have reported that they have no relationships relevant to the contents of this paper to disclose.
- American College of Cardiology Foundation