Endovascular Management of Patients with Takayasu Arteritis: Stents versus Stent Grafts

Our objective was to report the experience of endovascular therapy to treat patients with Takayasu arteritis (TA) and evaluate outcomes. A review was undertaken of TA patients treated with endovascular means during a 9-year (2004 to 2011) period. Patients were diagnosed using the American College of Rheumatology criteria and classified, based on angiographic criteria, using the Numano's Classification. The primary assessment of our analysis included patency of stent and stentgrafts. The secondary outcome measures included technical success, secondary interventions, and any periprocedural complications. A total of 25 arteritis patients were identified of which 14 patients had confirmed TA and were treated. Open surgical procedures were used in six patients, while the remaining eight underwent pure endovascular procedures or hybrid procedures, of which four had follow-up beyond 1 year. All four patients (all female), underwent six primary and five secondary vascular interventions. All lesions were stenotic in nature and the majority of patients (n = 3) had angiographic findings consistent with a combination of type I and type IV disease. Two abdominal stent grafts, one carotid stent, one innominate stent, one vertebral stent, one superior mesenteric stent, and bilateral renal stents were placed. Technical success was 100%, with the stent grafts staying patent longer than bare metal stents and patients with stent grafts undergoing fewer secondary interventions as opposed to those who had uncovered stents. Historically endovascular treatment of TA has been associated with poor outcomes with respect to patency. Newer endovascular techniques have allowed the use of alternatives methods that appear to be associated with better results. The use of stent grafts over uncovered stent will likely mitigate the risk of in-stent restenosis and occlusions.