Revascularization of Remaining Branch of Aorta in Advanced Takayasu Arteritis Protects Against Wide Range of Perfusion

Background Stroke is a major factor of morbidity in the patients with Takayasu arteritis (TA). Restenosis is more common with endovascular intervention than after bypass surgery, but vascular anastomosis is difficult due to calcification involving the whole thickness of the arterial wall in the burned-out stage of TA. We report a case of advanced TA in which endovascular treatment of the left subclavian artery improved cerebral blood flow (CBF) over a wide range of perfusion in the posterior and anterior circulation. Case Description During medical treatment for TA, a 57-year-old male patient gradually developed ischemic symptoms of both upper limbs and dizziness. Angiography showed occlusion of the brachiocephalic artery and severe stenosis of the left common carotid artery and left subclavian artery. Preoperative single-photon emission computed tomography revealed reductions in the resting CBF and vascular reactivity in the area of the carotid artery and vertebral basilar artery. Chest computed tomography showed calcification of the aortic arch and its branches, and this advanced diffuse calcification indicated probable difficulties in bypass surgery. Therefore we performed percutaneous transluminal angioplasty and stenting for the left subclavian artery. Postoperative single-photon emission computed tomography showed increases in resting CBF in the area of the bilateral internal carotid artery, as well as the vertebrobasilar artery. The patient's various ischemic symptoms improved significantly. Conclusions As collateral circulation is common in advanced TA, the ischemic area is large when the remaining proximal large vessels are occluded. Therefore revascularization of the remaining branch of the aorta in advanced TA may protect against a wide range of perfusion.