Outcomes of Percutaneous Intervention in Patients With Takayasu Arteritis.

Autor:	Joseph G; Department of Cardiology, Christian Medical College, Vellore, India. Electronic address: joseph59@gmail.com., Thomson VS; Department of Cardiology, Christian Medical College, Vellore, India., Attumalil TV; Department of Cardiology, Christian Medical College, Vellore, India., Mathen PG; Department of Cardiology, Christian Medical College, Vellore, India., Anandaraj AM; Department of Cardiology, Christian Medical College, Vellore, India., George OK; Department of Cardiology, Christian Medical College, Vellore, India., George PV; Department of Cardiology, Christian Medical College, Vellore, India., Goel R; Department of Clinical Rheumatology, Christian Medical College, Vellore, India., Kumar S; Department of Pediatric Rheumatology, Christian Medical College, Vellore, India., Mathew J; Department of Clinical Rheumatology, Christian Medical College, Vellore, India., Danda D; Department of Clinical Rheumatology, Christian Medical College, Vellore, India.
Jazyk:	angličtina
Zdroj:	Journal of the American College of Cardiology [J Am Coll Cardiol] 2023 Jan 03; Vol. 81 (1), pp. 49-64.
DOI:	10.1016/j.jacc.2022.10.024
Abstrakt:	Background: The status of vascular lesion treatment using percutaneous intervention (PI) in Takayasu arteritis (TAK) remains unresolved. Objectives: This study sought to develop PI strategies appropriate for TAK. Methods: A prospectively maintained single-center database of TAK PI procedures from 1996 to 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 or CBA results. PIs were repeated in restenotic lesions until sustained success was obtained. Aortic or peripheral aneurysms and spontaneous aortic dissections were treated with covered stents or endografts. Immunosuppressive therapy, started before PI, was continued long term. Results: A total of 942 patients underwent PI to treat 2,450 arterial lesions (2,365 stenoses or occlusions, 85 aneurysms or dissections) in 630 subclavian or 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 per lesion; range 1-7 PIs per lesion). Early success was obtained in 2,262 (92.3%), and late success in 1,460 (84.5%) of 1,727 lesions with a median of 39 months (IQR: 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 per lesion; covered stents (1.18 PIs per lesion) restenosed less than bare stents (1.51 PIs per 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% dissections and 8% ruptures or pseudoaneurysm formations. Aneurysms or 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. Competing Interests: Funding Support and Author Disclosures The authors have reported that they have no relationships relevant to the contents of this paper to disclose. (Copyright © 2023 The Authors. Published by Elsevier Inc. All rights reserved.)
Databáze:	MEDLINE
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