Herlin Bastien, Baud Jean-Michel, Chadenat Marie-Laure, Pico Fernando
Department of Neurology and Stroke Center, Versailles Saint Quentin en Yvelines University, Centre Hospitalier de Versailles, Versailles, France.
Angiology and Ultrasound Unit, Centre Hospitalier de Versailles, Versailles, France.
BMJ Case Rep. 2015 Oct 9;2015:bcr2015211094. doi: 10.1136/bcr-2015-211094.
A 43-year-old man was diagnosed with Takayasu arteritis, and treated with methotrexate and corticosteroids. While under treatment and with normal biological inflammatory parameters, he experienced an ischaemic stroke, successfully treated with intravenous thrombolysis (alteplase). The B-mode ultrasound examination revealed circumferential wall thickening of the left common carotid artery. Contrast-enhanced ultrasonography showed a progressive arterial wall enhancement of the left common carotid artery. This pathological enhancement indicates neovascularisation of the arterial wall, which is supposed to correlate with active vascular inflammation. After an increase in immunosuppressive treatment, follow-up contrast-enhanced ultrasonography no longer showed artery wall enhancement. Contrast-enhanced ultrasound examination is an inexpensive, reproducible and minimally invasive method, providing dynamic information on arterial wall neovascularisation and thus inflammation. This case illustrates that contrast-enhanced ultrasonography can be a useful tool for the management and follow-up of Takayasu arteritis, and its use as a marker of disease activity and arterial inflammation in Takayasu arteritis should be evaluated in further studies.
一名43岁男性被诊断为大动脉炎，并接受了甲氨蝶呤和皮质类固醇治疗。在治疗期间且生物学炎症指标正常时，他发生了缺血性卒中，通过静脉溶栓（阿替普酶）成功治疗。B型超声检查显示左颈总动脉壁周向增厚。超声造影显示左颈总动脉动脉壁强化逐渐加重。这种病理性强化提示动脉壁新生血管形成，推测与活跃的血管炎症相关。增加免疫抑制治疗后，随访超声造影不再显示动脉壁强化。超声造影检查是一种廉价、可重复且微创的方法，可提供有关动脉壁新生血管形成及炎症的动态信息。该病例表明，超声造影可成为大动脉炎管理和随访的有用工具，其作为大动脉炎疾病活动和动脉炎症标志物的用途应在进一步研究中进行评估。
