Division of Pediatric Cardiology, Department of Pediatrics, Changhua Christian Children's Hospital, Changhua, Taiwan.
School of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan.
J Korean Med Sci. 2018 Mar 5;33(10):e76. doi: 10.3346/jkms.2018.33.e76.
Concurrent involvement of bilateral renal and cerebral arteries, usually incurred as stenosis, is rare in childhood-onset Takayasu arteritis (c-TA). We report the case of a 14-year-old girl, with c-TA, presenting with transient ischemic attack after endovascular revascularization for renal artery stenosis and cerebrovascular stroke after surgical revascularization for cerebral artery stenosis associated with childhood-onset moyamoya syndrome. We deem that decrease of blood pressure by endovascular revascularization and improvement of cerebral perfusion by surgical revascularization may have jeopardized the cerebral deep watershed zone to cerebral ischemia followed by cerebral hyperperfusion syndrome and caused transient ischemic attack and cerebrovascular stroke in our patient. Revascularization could be a double-edge sword for c-TA patients presenting with concomitant renal artery stenosis and cerebral artery stenosis, and should be performed with caution. Quantitative analysis of cerebral blood flow by brain magnetic resonance imaging and angiography should be performed within 48 hours after surgical revascularization in c-TA.
双侧肾动脉和脑动脉同时受累，通常表现为狭窄，在儿童起病的 Takayasu 动脉炎（c-TA）中很少见。我们报告了一例 14 岁女孩的病例，患有 c-TA，在肾动脉狭窄的血管内再血管化后出现短暂性脑缺血发作，在脑动脉狭窄相关的儿童起病 moyamoya 综合征的手术再血管化后出现脑血管中风。我们认为，血管内再血管化导致血压下降和手术再血管化改善脑灌注可能危及大脑深部分水岭区，导致脑缺血后出现脑高灌注综合征，并导致我们的患者发生短暂性脑缺血发作和脑血管中风。对于同时存在肾动脉狭窄和脑动脉狭窄的 c-TA 患者，血管再通可能是一把双刃剑，应谨慎进行。在 c-TA 手术后 48 小时内，应通过脑磁共振成像和血管造影进行脑血流定量分析。
