This 18 year old girl was detected to have Takayasu arteritis with hypertension during evaluation for polyarthralgias. MR angiography revealed her to have severe renal artery stenosis left and left subclavian artery stenosis. Recent literature seems to suggest a higher failure rate and restenosis with stenting rather than with plain angioplasty. This goes contrary to what we see in atherosclerotic coronary artery disease stents have a higher success rates.
particularly in this case I will suggested angioplasty alone with DEB as a fisrt line of treatment.
First, anticoagulant coated balloon angioplasty and the second option is drug-eluting stent placement is appropriate.
First, anticoagulant coated balloon angioplasty and the second option is drug-eluting stent placement is appropriate.
Dear Dr. Subramanian,
I would clearly pass this question to Prof. Thomas Zeller at Universitäts-Herzzentrum Freiburg - Bad Krozigen. I did my peripheral interventional fellowship there 2008. He is a head of a very large peripheral interventional clinic and very knowledgeable what is up-to date in this particular matter. I.e. what specific device, and what specific DES, if any. Large randomized studies are lacking in this respect, and given the rapid development of devices the results will probably be outdated at the time of publication. We had a 3 year old boy who presented with arteritis, that was successfully managed over 2 yrs (my stay) by repeated (2007 & 2008) Scoring Balloon angioplasty of multiple infrarenal aortic branch obstructions. But he can answer what is the state of the art 2016 for in an young adult with Takayasu.
Pass an email to him, and refer to our discussion and say that Dr. Olli Leppänen strongly recommended to ask Prof Zeller's advice. If he is too busy (he is very busy indeed), pass the question to Dr. Ulrich Beschorner at the same department, and say greetings from me.
http://www.herzzentrum.de/kliniken-fachbereiche/klinik-fuer-kardiologie-und-angiologie-ii/forschung/klinische-studien-in-der-gefaessmedizin.html
Best regards,
Olli
Dear Dr Marek Iłżecki and Dr İhsan Yıldız,
Both of you have suggested angioplasty alone which seems congruent with the literature that I have seen.
Park HS. Eur J Radiol. 2013 Nov;82(11):1913-8.
Peng M. Int J Cardiol. 2016 Feb 15;205:117-23
Dear Dr Olli Leppänen,
I shall take you up on the offer and send the requisite email.
I still wonder why plain angioplasty beats stenting?
regards
I suggest angioplasty followed by drug coated balloon therapy. I recently treated a young patient with a variant of pseudoxanthma elastica who developed sma stenosis and mesenteric ischemia . Plain balloon therapy lasted 6 months with recurrence. I initially approached the patient as if it were fibromuscular dysplasia. But the patient recurred and I did cutting balloon therapy followed by DCB. She is now nearly 1 year out without recurrence.
Dear Dr Cheong J Lee,
Thanks for the suggestion.
Dear Dr Olli Leppänen,
I got a reply from Dr Zeller.
His recommendtion was to get the inflammation completely under control. Once controlled , in his words "Inflammatory lesions tend to be more rigid than atherosclerotic ones. For this purpose I every time prepare such lesions with either a scoring balloon (Angiosculpt, Spectranetics) or if the vessel diameter is at least 4mm with a Cutting Balloon (Boston Scientific) followed by drug eluting balloon angioplasty. Stenting in such young patients should be reserved for secondary treatment failure."
This exactly what was suggested by our interventional radiologist. He did the same and he too seemed against stents. It was his view that in inflammatory diseases like Takayasu (unlike atherosclerosis), the stent restenosis rates are higher as the vessel wall may be perceiving the stent as a foreign body and in an underlying autoimmune millieu and tends to overcorrect causing faster stent restenosis.
Anyway, we did the procedure of balloon angioplasty and the girl is doing well now.
Thanks to everyone and regards
Dear Dr. Subramanian,
There was a pretty good contribution from all of the people in this Q&A thread. I am happy that the patient is doing well.
all the best for you as well as the other colleagues in this thread.
best regards
Olli
- Badges
- Science topic
- Similar topics
- Biological Science
- Anatomy
- Tissue