Stroke and Transient Ischemic Attack in Takayasu's Arteritis: A Systematic Review and Meta-analysis.

BACKGROUND: Cerebrovascular disease is one of the possible consequences of Takayasu's arteritis (TA). However, little is known about the prevalence of stroke/transient ischemic attack (TIA) or its related clinical features among these patients. We have performed a systematic review and meta-analysis to estimate the rate and risk factors of stroke/TIA in TA as well as to explore associations with poorer outcomes. METHODS: MEDLINE and Embase were searched (October 2014) for observational studies of any design reporting prevalence rates of stroke/TIA among TA patients. Study selection, data collection, and quality assessment were done independently. Studies' results were pooled through random-effect meta-analysis. Heterogeneity was assessed with the I(2) test. RESULTS: Twenty-one studies (16 studies were of cohort design) were included (n = 3269). The pooled stroke/TIA prevalence rate estimate was 15.8% (95% confidence interval [CI]: 10.7%-22.6%, I(2) = 94%). Sensitivity analysis, excluding 8 studies with poorer TA diagnostic criteria, yielded a similar estimate but without statistical heterogeneity (15.7%; 95% CI: 13.6%-18.1%, I(2) = 5.5%). Data were unavailable to explore possible associations between patients' characteristics and stroke/TIA prevalence. CONCLUSION: Our results document a high prevalence of stroke/TIA among TA patients. However, there is scarce information on the type of stroke, the characteristics of the affected individuals, and stroke-associated morbidity and mortality. Future studies should aim to further explore this disabling complication to find the best treatment and prevention strategies.

Unusual Presentation Of A Case Of Takayasu Arteritis.

Takayasu arteritis is a rare disease of medium size and large vessels causing granulomatous inflammation of the involved territory. The most usual area involved is the arch of the aorta and its major branches. We came across an atypical presentation of this rare disease in our medicine department at Lahore General Hospital. A 52-year-old male presented with complaints of vertigo, bilateral upper limb cramps on physical activity. On examination, pulses were absent bilaterally in upper limbs. On CT angiography brachiocephalic and left subclavian arteries were not visualized. Inflammatory markers were not raised to the extent indicating a very aggressive disease. The patient was not meeting the age limit as described by Ishikawa diagnostic criteria. The patient was referred to the cardiovascular surgery department for revascularization.

Carotid Artery Stenting in Right-sided Aortic Arch: A Case Report.

The present report describes a patient with pseudo-occlusion of the left internal carotid artery accompanied by aortic anomalies consisting of right-sided aortic arch with aberrant left subclavian artery arising from Kommerell's diverticulum. Initial attempt of carotid artery stenting via the trans-femoral approach was unsuccessful because of low origin of the left common carotid artery. Therefore, carotid artery stenting (CAS) via the trans-brachial approach was successfully performed with distal balloon protection. Eight months later, the patient presented with restenosis of the left internal carotid artery, and CAS via the trans-brachial approach was performed again. CAS via the trans-brachial approach should be considered when standard femoral access is relatively contraindicated due to aortic anomalies consisting of a right-sided aortic arch.