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We reported, for first time in world literature, our experience with stent – supported angioplasty in Takayasu arteritis [TA] in 1998 & a follow – up [FU] study of de-novo stenting in 2000. Long-term outcome & outcome predictors after endovascular treatment of TA has not been reported.
This prospective study analyzed results & outcomes of 60 consecutive patients (mean age 28 + 15.2 years; 44 women [73.3%]) with angiographically proven TA over two decades. Angiographic classification-15 patients [25%] had Type I; 12 patients [20%] had Type V; 9 [15%] each had Type IIa, III and IV & 6 [10%] had Type IIb disease. Of 80 interventions; 68 were stent-supported: in ostial / long-segment/ chronically occluded lesions [CTO], for incomplete relief/dissection post-angioplasty & in case of residual gradient at rest after balloon angioplasty. Bare metal stents were deployed in all; except 3 coronary lesions, where drug-eluting stents deployed. Self-expanding stents deployed in non-ostial lesions, balloon expandable stents in ostial lesions. Peak systolic gradient [PSG] was measured pre-and post-procedure in aortic angioplasty/stenting. 7 patients underwent staged interventions in multiple vascular beds. 12 patients [4 each] underwent single stage bilateral carotid / renal / subclavian artery stenting. 77 interventions [96.25%] were technically successful [in 2 subclavian & 1 carotid, procedure aborted as guidewire failed to cross CTO]. This hemodynamic benefit led to improved effort tolerance and better Quality of Life [QoL] in patients.
1. Median follow-up [FU] period:9.5 years in 56 patients (interquartile range [IQR] 8 months – 19.5 years). 2. Restenosis:11 [19.65 %]: 6 carotid, 2 subclavian & 3 renal. Restenosis rates higher in carotid artery; least in aortic lesions. 3. Active disease with biological inflammation at time of revascularization (P < 0.001) independently associated with higher restenosis rates/arterial complications. Stent-supported angioplasty in 3 cases of RAS & PTBA in 2 subclavian in-stent restenosis [ISR] had good results. Interventions in carotid ISR gave uniformly suboptimal results. 4 patients died on FU: 2-stroke, 1 - renal failure, 1- ATT induced hepatic failure.
Endovascular treatment of symptomatic TA is safe & efficacious with good long-term results. In-stent restenosis rates are higher in patients with active disease; in small vessels -carotid; in long/calcified lesions. Outcomes of vascular intervention may be improved by ensuring disease quiescence with optimal immune-modulatory therapy.
ENDOVASCULAR: Peripheral Vascular Disease and Intervention