Endovascular Therapy for Supra-aortic Artery Stenosis Caused by Takayasu's Arteritis: Long Term Results.

Abstract

Management of supra-aortic artery stenosis caused by Takayasu's arteritis (SAASTA) by endovascular therapy remains an unresolved issue in clinical practice. This study investigated the peri-operative and long term outcomes of endovascular therapy in patients with SAASTA. From January 2002 to December 2021, 219 consecutive patients with symptomatic SAASTA undergoing endovascular therapy were enrolled in this study. All lesions underwent percutaneous transluminal angioplasty with a plain balloon or a drug coated balloon. Adjunctive stent implantation was performed in cases of flow limiting dissections and or residual stenosis exceeding 50% following initial balloon dilatation. Peri-operative and long term clinical outcomes were recorded and analysed. Three hundred and seventy-five lesions were recanalised in 265 endovascular procedures. Supra-aortic artery related symptoms were relieved in 93.2% of patients after the initial procedure. Peri-operative neurological complications occurred in eight of 219 cases (3.7%). The overall rates of 30 day death and stroke were both 0.5%. Follow up data were available for 186 patients (84.9%) during a median follow up of 73.7 months (interquartile range 25.1, 126.3), and re-stenosis occurred in 155 (41.3%) of 375 lesions. Kaplan-Meier analysis demonstrated superior primary patency rates in lesions managed with balloon angioplasty alone, including both plain balloons (42.7%) and drug coated balloons (64.0%), compared with lesions requiring adjunctive stenting (26.6%; p = .024 for plain balloon vs. stent, p = .032 for drug coated balloon vs. stent). No statistically significant difference was observed between the two balloon only strategies (p = .35). Adjunctive stent placement (hazard ratio [HR] 1.54, 95% confidence interval [CI] 1.02 - 2.34; p = .042) and active inflammation (HR 1.54, 95% CI 1.03 - 2.30; p = .036) were independent predictors of re-stenosis. The recurrence rates of SAASTA related symptoms at one, five, and ten years were 15.2%, 26.7%, and 34.1%, respectively. The cumulative composite clinical event free survival rates at these time points were 98.9%, 90.2%, and 82.6%, respectively. Endovascular therapy was safe and effective for patients with SAASTA. Post-operative re-stenosis was a major challenge, particularly in lesions requiring adjunctive stenting.