The following is a summary of “Outcomes of Percutaneous Intervention in Patients With Takayasu Arteritis,” published in the January 2023 issue of Cardiology by Joseph, et al.
Takayasu arteritis (TAK) has an unclear situation regarding the use of percutaneous intervention (PI) to treat vascular lesions. For a study, researchers sought to create PI tactics suitable for TAK.
A retrospective analysis was performed on a prospectively kept single-center database of TAK PI operations from 1996 to 2022. Obstructive lesions were treated with balloon angioplasty (BA), cutting-balloon angioplasty (CBA), or elective stenting (using bare or coated stents), with supplementary stenting for subpar BA or CBA outcomes. In restenotic lesions, PIs were applied repeatedly until sustained success was attained. Covered stents or endograft were used to treat spontaneous aortic dissections, and peripheral or aortic aneurysms. Before PI, immunosuppressive medication was started and sustained for a long time.
About 3,805 (1.55 PIs per lesion; range 1-7 PIs per lesion) PIs were carried out on 942 patients to treat 2,450 arterial lesions in 630 subclavian or axillary, 586 renal, 463 aortic, 333 carotids, 188 mesenteric, 116 iliac, 71 coronary, and 63 other arteries. These lesions included 2,365 stenoses or occlusions as well as 85 aneurysms or dissections. Of the 1,727 lesions, early success was achieved in 2,262 (92.3%) and late success in 1,460 (84.5%) with a median follow-up of 39 months (IQR: 15-85 months). In obstructive lesions, repeated PIs boosted late success from 48.6% to 83.3%. With 1.49 PIs per lesion, a total of 1,687 elective stenting lesions achieved 88% late success; covered stents (1.18 PIs per lesion) restenosed less frequently than bare stents (1.51 PIs per lesion; P< 0.001). Of the 513 BA-treated lesions, 183 (or 36%) had successful outcomes without the need for further stenting, while 122 CBA-treated lesions had dissections of 19% and ruptures or pseudoaneurysm forms of 8%. After PI, aneurysms or dissections had a late success rate of 91.3%. In 415 (17%) lesions, there were a total of 472 complications; 375 (79%) of these were resolved.
The majority of vascular lesions in TAK may be successfully, securely, and permanently repaired with stent-based PI techniques.
Reference: jacc.org/doi/10.1016/j.jacc.2022.10.024