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Journal of Neurology

, Volume 265, Issue 4, pp 757–763 | Cite as

Cerebrovascular events in Takayasu arteritis: a multicenter case-controlled study

  • Priscille Couture
  • Thibaud Chazal
  • Charlotte Rosso
  • Julien Haroche
  • Anne Léger
  • Baptiste Hervier
  • Sandrine Deltour
  • Zahir Amoura
  • Fleur Cohen Aubart
Original Communication
  • 315 Downloads

Abstract

Objectives

Takayasu arteritis (TA) is a giant cell arteritis usually affecting young women and characterized by inflammatory and ischemic signs of large vessel involvement, including extracranial cerebral arteries. The impact of stroke on TA prognosis has not been well evaluated.

Methods

We performed a retrospective multicenter review of patients with definite TA who experienced at least one stroke and compared the findings to 17 matched patients with TA diagnosis without neurological involvement.

Results

Seventeen patients (15 women, median age at stroke diagnosis 44 years) receiving a diagnosis of TA and stroke between 2002 and 2016 in our institution were included, from a cohort of 126 patients suffering from TA (13.5%). At diagnosis, patients from both groups had comparable cardiovascular risk factors. The first cerebrovascular event was ischemic stroke (n = 15) or transient ischemic attack (n = 2). In eight patients, stroke occurred after the TA diagnosis was made. In four patients, stroke occurred after carotid surgery. At the end of follow-up, 59% of patients had a neurological impairment, 35% had a recurrence of stroke, and 24% suffered from epilepsy.

Conclusions

Stroke is a major cause of disability in TA patients. Internal carotid surgery may be performed with caution because of the risk of stroke after the procedure.

Keywords

Takayasu arteritis Stroke Carotid artery Surgery 

Notes

Author contributions

All the authors (PC, TC, CR, JH, AL, BH, ZA and FCA) contributed to drafting/revising the manuscript for content and study design as well as analysis and interpretation of the data. TC, PC, CR, BH, and FCA contributed to the acquisition of data. PC and FCA conducted the statistical analysis. ZA and FCA coordinated the study. All the authors approved the final submitted version.

Compliance with ethical standards

Conflicts of interest

The authors declare no conflicts of interest and no disclosures relevant to the manuscript.

Ethical standards

This study was performed in compliance with the Helsinki Declaration and its later amendments.

Informed consent

For this type of study, formal consent was not required.

Funding

This work was not supported by any funding.

References

  1. 1.
    Abisror N, Mekinian A, Lavigne C, Vandenhende MA, Soussan M, Fain O, Club Rhumatismes et I, Snfmi (2013) Tocilizumab in refractory Takayasu arteritis: a case series and updated literature review. Autoimmun Rev 12:1143–1149CrossRefPubMedGoogle Scholar
  2. 2.
    Alibaz-Oner F, Direskeneli H (2015) Update on Takayasu’s arteritis. Presse Med 44:e259–e265CrossRefPubMedGoogle Scholar
  3. 3.
    Arend WP, Michel BA, Bloch DA, Hunder GG, Calabrese LH, Edworthy SM, Fauci AS, Leavitt RY, Lie JT, Lightfoot RW Jr et al (1990) The American College of Rheumatology 1990 criteria for the classification of Takayasu arteritis. Arthritis Rheum 33:1129–1134CrossRefPubMedGoogle Scholar
  4. 4.
    Arnaud L, Haroche J, Limal N, Toledano D, Gambotti L, Costedoat Chalumeau N, Le Thi Huong Boutin D, Cacoub P, Cluzel P, Koskas F, Kieffer E, Piette JC, Amoura Z (2010) Takayasu arteritis in France: a single-center retrospective study of 82 cases comparing white, North African, and black patients. Medicine 89:1–17CrossRefPubMedGoogle Scholar
  5. 5.
    Bejot Y, Couvreur G, Ricolfi F, Osseby GV, Cochet A, Giroud M (2011) Acute cerebrovascular manifestation of Takayasu arteritis. Am J Med 124:e5–e6CrossRefPubMedGoogle Scholar
  6. 6.
    Bond KM, Nasr D, Lehman V, Lanzino G, Cloft HJ, Brinjikji W (2017) Intracranial and extracranial neurovascular manifestations of Takayasu arteritis. AJNR Am J Neuroradiol 38:766–772CrossRefPubMedGoogle Scholar
  7. 7.
    Caballero PE (2011) Common carotid artery aneurysm revealing Takayasu’s arteritis. J Stroke Cerebrovasc Dis Off J Natl Stroke Assoc 20:556–558CrossRefGoogle Scholar
  8. 8.
    Camara-Lemarroy CR, Lara-Campos JG, Perez-Contreras E, Rodriguez-Gutierrez R, Galarza-Delgado DA (2013) Takayasu’s arteritis and posterior reversible encephalopathy syndrome: a case-based review. Clin Rheumatol 32:409–415CrossRefPubMedGoogle Scholar
  9. 9.
    Comarmond C, Plaisier E, Dahan K, Mirault T, Emmerich J, Amoura Z, Cacoub P, Saadoun D (2012) Anti TNF-alpha in refractory Takayasu’s arteritis: cases series and review of the literature. Autoimmun Rev 11:678–684CrossRefPubMedGoogle Scholar
  10. 10.
    de Paula LE, Alverne AR, Shinjo SK (2013) Clinical and vascular features of Takayasu arteritis at the time of ischemic stroke. Acta Reumatol Port 38:248–251PubMedGoogle Scholar
  11. 11.
    Duarte MM, Geraldes R, Sousa R, Alarcao J, Costa J (2016) Stroke and transient ischemic attack in Takayasu’s arteritis: a systematic review and meta-analysis. J Stroke Cerebrovasc Dis Off J Natl Stroke Assoc 25:781–791CrossRefGoogle Scholar
  12. 12.
    Fields CE, Bower TC, Cooper LT, Hoskin T, Noel AA, Panneton JM, Sullivan TM, Gloviczki P, Cherry KJ Jr (2006) Takayasu’s arteritis: operative results and influence of disease activity. J Vasc Surg 43:64–71CrossRefPubMedGoogle Scholar
  13. 13.
    Ham SW, Kumar SR, Rowe VL, Weaver FA (2011) Disease progression after initial surgical intervention for Takayasu arteritis. J Vasc Surg 54:1345–1351CrossRefPubMedGoogle Scholar
  14. 14.
    Hao R, Zhang J, Ma Z, Xiao M, Zhou L, Kang N, Liang X, Li F (2016) Takayasu’s arteritis presenting with common carotid artery dissection: a rare case report. Exp Ther Med 12:4061–4063CrossRefPubMedPubMedCentralGoogle Scholar
  15. 15.
    Herlin B, Baud JM, Chadenat ML, Pico F (2015) Contrast-enhanced ultrasonography in Takayasu arteritis: watching and monitoring the arterial inflammation. BMJ Case Rep.  https://doi.org/10.1136/bcr-2015-211094 PubMedPubMedCentralGoogle Scholar
  16. 16.
    Hu J, Huang H, Zhang X, Li G, Liu Q, Wu M, Li G, Chen K, Shi S (2012) Stent placement for treatment of long segment (≥ 80 mm) carotid artery stenosis in patients with Takayasu disease. J Vasc Interv Radiol 23:1473–1477CrossRefPubMedGoogle Scholar
  17. 17.
    Humayun MA, Masood A, Waseem T, Ahmad F, Raza T (2014) An unusual cause of stroke in a young female. Am J Emerg Med 32(685):e683–e685Google Scholar
  18. 18.
    Hwang J, Kim SJ, Bang OY, Chung CS, Lee KH, Kim DK, Kim GM (2012) Ischemic stroke in Takayasu’s arteritis: lesion patterns and possible mechanisms. J Clin Neurol 8:109–115CrossRefPubMedPubMedCentralGoogle Scholar
  19. 19.
    Jordan NP, Bezanahary H, D’Cruz DP (2015) Increased risk of vascular complications in Takayasu’s arteritis patients with positive lupus anticoagulant. Scand J Rheumatol 44:211–214CrossRefPubMedGoogle Scholar
  20. 20.
    Kato Y, Dembo T, Takeda H, Fukuoka T, Nagoya H, Deguchi I, Maruyama H, Furuya D, Tanahashi N (2010) Stroke as a manifestation of Takayasu’s arteritis likely due to distal carotid stump embolism. Intern Med 49:695–699CrossRefPubMedGoogle Scholar
  21. 21.
    Katoh N, Kubota M, Shimojima Y, Ishii W, Matsuda M, Akamatsu T, Ikeda S (2010) Takayasu’s arteritis in a patient with Crohn’s disease: an unexpected association during infliximab therapy. Intern Med 49:179–182CrossRefPubMedGoogle Scholar
  22. 22.
    Kawano H, Toyoda K, Otsubo R, Hishikawa T, Minematsu K (2009) Tortuous carotid artery lumens in Takayasu’s arteritis. J Stroke Cerebrovasc Dis Off J Natl Stroke Assoc 18:403–404CrossRefGoogle Scholar
  23. 23.
    Keenan NG, Mason JC, Maceira A, Assomull R, O’Hanlon R, Chan C, Roughton M, Andrews J, Gatehouse PD, Firmin DN, Pennell DJ (2009) Integrated cardiac and vascular assessment in Takayasu arteritis by cardiovascular magnetic resonance. Arthritis Rheum 60:3501–3509CrossRefPubMedGoogle Scholar
  24. 24.
    Kim HJ, Suh DC, Kim JK, Kim SJ, Lee JH, Choi CG, Yoo B, Kwon SU, Kim JS (2005) Correlation of neurological manifestations of Takayasu’s arteritis with cerebral angiographic findings. Clin Imaging 29:79–85CrossRefPubMedGoogle Scholar
  25. 25.
    Kumar VS, Dutt S, Bhat R (2014) Takayasu’s arteritis—stroke as an initial presentation. J Assoc Physicians India 62:623–627PubMedGoogle Scholar
  26. 26.
    Kumral E, Evyapan D, Aksu K, Keser G, Kabasakal Y, Balkir K (2002) Microembolus detection in patients with Takayasu’s arteritis. Stroke 33:712–716CrossRefPubMedGoogle Scholar
  27. 27.
    Lim AY, Lee GY, Jang SY, Gwag HB, Choi SH, Jeon ES, Cha HS, Sung K, Kim YW, Kim SM, Choe YH, Kim DK (2015) Gender differences in clinical and angiographic findings of patients with Takayasu arteritis. Clin Exp Rheumatol 33:S-132–S-137Google Scholar
  28. 28.
    Liu Q, Dang A, Lv N, Wang X, Zheng D (2016) Anaemia and low body mass index are associated with increased cardiovascular disease in patients with Takayasu arteritis. Clin Exp Rheumatol 34:S16–S20PubMedGoogle Scholar
  29. 29.
    Maeda Y, Taguchi H, Kudo T, Okano Y (2016) Takayasu arteritis and ischaemic stroke. QJM 109:45–46CrossRefPubMedGoogle Scholar
  30. 30.
    Makin K, Isbel M, Nossent J (2017) Frequency, presentation, and outcome of Takayasu arteritis in Western Australia. Mod Rheumatol 27(6):1019–1023CrossRefPubMedGoogle Scholar
  31. 31.
    Monti L, Servillo R, Grazzini I, Khader L, Acampa M, Cerase A (2017) Neuroimaging of Takayasu arteritis in a patient with ulcerative rectocolitis. J Stroke Cerebrovasc Dis Off J Natl Stroke Assoc 26:e129–e132CrossRefGoogle Scholar
  32. 32.
    Mustafa KN, Hadidy A, Sweiss NJ (2010) Clinical and radiological features of Takayasu’s arteritis patients in Jordan. Rheumatol Int 30:1449–1453CrossRefPubMedGoogle Scholar
  33. 33.
    Numano F, Okawara M, Inomata H, Kobayashi Y (2000) Takayasu’s arteritis. Lancet 356:1023–1025CrossRefPubMedGoogle Scholar
  34. 34.
    Osman M, Emery D, Yacyshyn E (2015) Tocilizumab for treating Takayasu’s arteritis and associated stroke: a case series and updated review of the literature. J Stroke Cerebrovasc Dis Off J Natl Stroke Assoc 24:1291–1298CrossRefGoogle Scholar
  35. 35.
    Park KC, Kim JH, Yoon SS, Heo SH (2008) Takayasu’s disease presenting with atherothrombotic ischaemic stroke. Neurol Sci 29:363–366CrossRefPubMedGoogle Scholar
  36. 36.
    Park MC, Lee SW, Park YB, Chung NS, Lee SK (2005) Clinical characteristics and outcomes of Takayasu’s arteritis: analysis of 108 patients using standardized criteria for diagnosis, activity assessment, and angiographic classification. Scand J Rheumatol 34:284–292CrossRefPubMedGoogle Scholar
  37. 37.
    Pereira VC, de Freitas CC, Luvizutto GJ, Sobreira ML, Peixoto DE, Magalhaes Ido N, Bazan R, Braga GP (2014) Stroke as the first clinical manifestation of Takayasu’s arteritis. Case Rep Neurol 6:271–274CrossRefPubMedPubMedCentralGoogle Scholar
  38. 38.
    Pfefferkorn T, Bitterling H, Hufner K, Opherk C, Schewe S, Pfister HW, Straube A, Dichgans M (2008) Malignant hemispheric infarction in Takayasu arteritis. J Neurol 255:1425–1426CrossRefPubMedGoogle Scholar
  39. 39.
    Ringleb PA, Strittmatter EI, Loewer M, Hartmann M, Fiebach JB, Lichy C, Weber R, Jacobi C, Amendt K, Schwaninger M (2005) Cerebrovascular manifestations of Takayasu arteritis in Europe. Rheumatology 44:1012–1015CrossRefPubMedGoogle Scholar
  40. 40.
    Rustagi T, Majumder S (2011) Crohn’s–Takayasu’s arteritis overlap with hypercoagulability: an optimal milieu for ischemic stroke. J Dig Dis 12:142–146CrossRefPubMedGoogle Scholar
  41. 41.
    Saadoun D, Lambert M, Mirault T, Resche-Rigon M, Koskas F, Cluzel P, Mignot C, Schoindre Y, Chiche L, Hatron PY, Emmerich J, Cacoub P (2012) Retrospective analysis of surgery versus endovascular intervention in Takayasu arteritis: a multicenter experience. Circulation 125:813–819CrossRefPubMedGoogle Scholar
  42. 42.
    Sharma BK, Jain S (1998) A possible role of sex in determining distribution of lesions in Takayasu Arteritis. Int J Cardiol 66(Suppl 1):S81–S84CrossRefPubMedGoogle Scholar
  43. 43.
    Skeik N, Rumery KK, Udayakumar PD, Crandall BM, Warrington KJ, Sullivan TM (2013) Concurrent Takayasu arteritis with common variable immunodeficiency and moyamoya disease. Ann Vasc Surg 27(240):e213–e248Google Scholar
  44. 44.
    Soto ME, Espinola N, Flores-Suarez LF, Reyes PA (2008) Takayasu arteritis: clinical features in 110 Mexican Mestizo patients and cardiovascular impact on survival and prognosis. Clin Exp Rheumatol 26:S9–S15PubMedGoogle Scholar
  45. 45.
    Srinivas BC, Patra S, Reddy B, Nagesh CM, Manjunath CN (2013) Reocclusion and stroke due to immediate plaque protrusion following endovascular treatment of carotid artery successfully treated with intra-arterial urokinase and stent in stent in a patient with Takayasu arteritis with severe disease of all arch vessels. Cardiovasc Interv Ther 28:394–397CrossRefPubMedGoogle Scholar
  46. 46.
    Vanoli M, Daina E, Salvarani C, Sabbadini MG, Rossi C, Bacchiani G, Schieppati A, Baldissera E, Bertolini G, Itaka Study G (2005) Takayasu’s arteritis: a study of 104 Italian patients. Arthritis Rheum 53:100–107CrossRefPubMedGoogle Scholar
  47. 47.
    Wheeler G, Kropf J, Jeanmonod R (2012) Vasculitis presenting with myocardial infarction, stroke, and aortitis in a middle-aged man. J Emerg Med 43:655–658CrossRefPubMedGoogle Scholar
  48. 48.
    Yang L, Zhang H, Jiang X, Song L, Qin F, Zou Y, Wu H, Bian J, Zhou X, Hui R, Zheng D (2015) Clinical features and outcomes of Takayasu arteritis with neurological symptoms in China: a retrospective study. J Rheumatol 42:1846–1852CrossRefPubMedGoogle Scholar
  49. 49.
    Zhu FP, Luo S, Wang ZJ, Jin ZY, Zhang LJ, Lu GM (2012) Takayasu arteritis: imaging spectrum at multidetector CT angiography. Br J Radiol 85:e1282–e1292CrossRefPubMedPubMedCentralGoogle Scholar

Copyright information

© Springer-Verlag GmbH Germany, part of Springer Nature 2018

Authors and Affiliations

  1. 1.Service de Médecine 2, Institut e3m, Centre National de Référence Maladies Systémiques Rares, Lupus systémique et Syndrome des Anticorps AntiphospholipidesAssistance Publique-Hôpitaux de Paris, Hôpital de la Pitié-SalpêtrièreParisFrance
  2. 2.Service de Neurologie vasculaireAssistance Publique-Hôpitaux de Paris, Hôpital de la Pitié-SalpêtrièreParisFrance
  3. 3.Sorbonne Université, Université Paris VI Pierre et Marie CurieParisFrance
  4. 4.Département d’immunologie cliniqueAssistance Publique-Hôpitaux de Paris, Hôpital de la Pitié-SalpêtrièreParisFrance

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