J Korean Med Sci.  2008 Jun;23(3):551-555. 10.3346/jkms.2008.23.3.551.

Takayasu's Arteritis Treated by Percutaneous Transluminal Angioplasty with Stenting in the Descending Aorta

• Shim BJ
• Youn HJ
• Kim YC
• Kim WT
• Choi YS
• Lee DH
• Park CS
• Oh YS
• Chung WS
• Kim JH
• Choi KB
• Hong SJ
• Jung SE
• Hahn ST

• KMID: 1786902
• DOI: http://doi.org/10.3346/jkms.2008.23.3.551

Abstract

A 17-yr-old young woman was referred to our hospital with a 2-yr history of claudication of the lower extremities and severe arterial hypertension. Physical examination revealed significantly different blood pressures between both arms (160/92 and 180/95 mmHg) and legs (92/61 and 82/57 mmHg). The hematological and biochemical values were within their normal ranges, except for the increased erythrocyte sedimentation rate (83 mm/hr) and C-reactive protein (6.19 mg/L). On 3- dimensional computed tomographic angiography, the ascending aorta, the aortic arch and its branches, and the thoracic and, descending aorta, but not the renal artery, were shown to be stenotic. The diagnosis of type IIb Takayasu's arteritis was made according to the new angiographic classification of Takayasu's arteritis, Takyasu conference 1994. Percutaneous transluminal angioplasty with stenting was performed on the thoracic and abdominal aorta. After the interventional procedures, the upper extremity blood pressure improved from 162/101 mmHg to 132/85 mmHg, respectively. She has been free of claudication and there have been no cardiac events during 2-yr of clinical follow-up.

Keyword

Arteritis; Stenosis; Angioplasty

MeSH Terms

Adolescent
Angiography
*Angioplasty, Balloon
Aorta, Abdominal/radiography
*Aorta, Thoracic/radiography
Carotid Arteries/ultrasonography
Female
Humans
*Stents
Takayasu Arteritis/radiography/*therapy/ultrasonography
Tomography, X-Ray Computed

Figure

• 

  Fig. 1 Neck MR angiography demonstrates the cut-off, filling and near total occlusions (arrow) at the osteal lesions of the left common carotid artery on the posterior-anterior view.

• 

  Fig. 2 The neck carotid Doppler sonogram. (A) Right common carotid artery shows normal luminal diameter without abnormalities. (B) and (C) Color flow doppler ultrasound scan (B) and spectral analysis (C) show a normal arterial flow in the right common carotid artery. (D) Left common carotid artery shows marked wall thickening and luminal narrowing. (E) and (F) Decreased blood flow on Color flow Doppler ultrasound scan (E) and decreased peak systolic pressure on spectral analysis (F) are noted in the left common carotid artery.

• 

  Fig. 3 (A) 3D-CT angiography shows focal stenosis in the descending aorta, but not the renal artery. (B) Percutaneous transluminal angioplasty was performed in the descending aorta using a 4.0/12 mm balloon catheter. (C) A 4.0/14 mm Niti-S stent in the aorta was inserted after ballooning.

• 

  Fig. 4 24-hr ABPM shows more than a 30 mmHg mean difference between the upper extremity blood pressure and the lower extremity blood pressure. (A) 24-hr ABPM of an arm before and after PTA (B) 24-hr ABPM of a leg before and after PTA. 24-hr ABPM, 24 hr-ambulatory blood pressure monitoring; PTA, percutaneous angioplasty.

• 

  Fig. 5 (A) CT angiography shows the focal stenosis in the descending aorta beyond both renal arteries. (B) 3D reconstruction of CT angiography shows severe stenosis of the abdominal aorta, beyond both renal arteries. (C) After the insertion of a stent-graft, CT angiography shows the dilation of stenotic segments in the descending aorta. (D) 3D reconstruction of CT angiography after the insertion of a stent-graft.

• 

  Fig. 6 Changes of ESR and CRP levels.

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