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Case 10

History

  • 37 year old female with known Takayasu arteritis
  • Follow up MRI post immunosuppressive treatment

Findings



Takayasu arteritis
  • 1/1000 people in the US. More common in Asia
  • Granulomatous arteritis unknown aetiology affects the thoracic and abdominal aorta
  • Early phase: inflammatory- low-grade fever, tachycardia, pain and fatigue (5-20 year interval)
  • Late phase: symptomatic arterial occlusive phase

Diagnosis

  • Type I Classic pulseless type involves brachioephalic trunk, carotid and subclavian arteries
  • Type II Combination of types I and II
  • Type III Atypical coarctation type that involves the thoracic and abdominal aorta distal to the arch and its major branches
  • Type IV Dilated type that involves extensive dilatation of the length of the aorta and its major branches

Treatment

  • Treatment: Corticosteroids. Methotrexate, cyclophosphamide.
  • Angioplasty- not in the acute phase
Subclavian Steal
  • Subclavian steal phenomenon: retrograde flow in the vertebral artery secondary to proximal subclavian artery occlusion or stenosis
  • Subclavian steal syndrome: transient neurologic symptoms related to cerebral ischaemia. Worse if concomitant arterial disease in extracranial/ intracranial carotids. Classically provoked by arm exercise
  • Treatment generally reserved for debilitating vertebrobasilar TIA’s
  • Angioplasty+/- stenting
  • Surgical: Carotid-subclavian bypass/ Carotid-subclavian transposition
  • Always evaluate for other extra and intra cranial lesions