J Korean Med Sci.  2018 Mar;33(10):e76. 10.3346/jkms.2018.33.e76.

Revascularization of Concurrent Renal and Cerebral Artery Stenosis in a 14-Year-Old Girl with Takayasu Arteritis and Moyamoya Syndrome

• Lee ML
• Chang MY
• Chang TM
• Yang RC
• Chang MC
• Yang AD

• KMID: 2405008
• DOI: http://doi.org/10.3346/jkms.2018.33.e76

Abstract

Concurrent involvement of bilateral renal and cerebral arteries, usually incurred as stenosis, is rare in childhood-onset Takayasu arteritis (c-TA). We report the case of a 14-year-old girl, with c-TA, presenting with transient ischemic attack after endovascular revascularization for renal artery stenosis and cerebrovascular stroke after surgical revascularization for cerebral artery stenosis associated with childhood-onset moyamoya syndrome. We deem that decrease of blood pressure by endovascular revascularization and improvement of cerebral perfusion by surgical revascularization may have jeopardized the cerebral deep watershed zone to cerebral ischemia followed by cerebral hyperperfusion syndrome and caused transient ischemic attack and cerebrovascular stroke in our patient. Revascularization could be a double-edge sword for c-TA patients presenting with concomitant renal artery stenosis and cerebral artery stenosis, and should be performed with caution. Quantitative analysis of cerebral blood flow by brain magnetic resonance imaging and angiography should be performed within 48 hours after surgical revascularization in c-TA.

Keyword

Takayasu Arteritis; Moyamoya Syndrome; Renovascular Hypertension; Revascularization; Cerebral Hyperperfusion Syndrome

MeSH Terms

Adolescent*
Angiography
Blood Pressure
Brain
Brain Ischemia
Cerebral Arteries*
Cerebrovascular Circulation
Constriction, Pathologic*
Female*
Humans
Hypertension, Renovascular
Ischemic Attack, Transient
Magnetic Resonance Imaging
Moyamoya Disease*
Perfusion
Renal Artery Obstruction
Stroke
Takayasu Arteritis*