Though luminal changes in Takayasu arteritis (TA) are well seen with conventional angiography, mural changes can be best seen with CTA. Cervical vasculature is affected in over 75% of patients. Cervical vessel findings on CTA and clinical correlates have not been fully described.
Methods: Thirteen patients with TA were identified by ICD-9 diagnosis code at two urban hospitals. Diagnosis was confirmed based on American College of Rheumatology criteria for TA.
Results: Of 4 male, 9 female (mean age, 37; 5 Latin Am.; 3 Asian; 3 African; 2 North Am.) patients, 10 (77%) had dedicated cervical imaging (CTA/MRA). Ten had neurologic symptoms; visual (46%); weakness/numbness (31%); syncope/dizziness (23%). Nine (69%) had active disease at time of imaging. Twelve (92%) had cervical vessel lesions; 11 (85%) with wall thickening; 11 with vessel stenosis. On average 3 vessels were affected, most commonly L subclavian (69%), L common carotid (54%). Of the 6 patients (46%) with occlusions, all had collateral flow; in 4, wall enhancement, intimal vessel hyperplasia was seen. Three patients imaged before aorto-carotid bypass grafting had an average of 7 diseased cervical vessels. All had strokes soon after bypass, two ischemic with hemorrhagic conversion, a third with IPH/IVH. Two patients had cerebrovascular symptom exacerbation during menses; one was successfully treated with hysterectomy. Findings on cervical imaging directly changed surgical or medical management in 9 (77%) cases.
Conclusion: Cervical vessel involvement is pervasive in TA. Wall thickening, a common finding in early and active TA, is not part of current diagnostic criteria and may warrant inclusion. Given the prevalence of cervical vessel disease and its clinical implications, cervical vascular imaging should be considered in all TA patients, particularly those with neurologic symptoms. Combining chest/cervical CTA into a single protocol may be beneficial.