National Center for Cardiovascular Diseases, Fuwai Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China.
Beijing Anzhen Hospital, Capital Medical University, Beijing, China.
Arthritis Care Res (Hoboken). 2021 Nov;73(11):1678-1688. doi: 10.1002/acr.24387. Epub 2021 Oct 13.
Evidence-based studies on endovascular approaches for childhood Takayasu arteritis (TAK) are limited. Our objective was to present the largest current real-world scenario for patients with childhood TAK undergoing interventions and their postinterventional outcomes.
Data were collected for patients with childhood TAK admitted from 2002 to 2017. Complication/reintervention-free survival was projected by Kaplan-Meier methods. Associated factors for intervention and predictors for postinterventional complications/reinterventions were assessed via regression models.
Among 101 patients enrolled, 69 (68.3%) underwent 121 interventions (angioplasty 95, stenting 26) during a 3.1-year follow-up. Compared with the nonintervention group, the intervention group independently associated with a male population (odds ratio [OR] 0.27, P = 0.035) and type IV disease (OR 17.92, P = 0.001). Male sex also marginally indicated a risk for reintervention (hazard ratio [HR] 3.22, P = 0.05). Baseline retinopathy, delay in diagnosis, and descending thoracic aorta involvement were associated with stent insertion (P < 0.05). Hypertension secondary to renal artery stenosis (RAS; 59.4%) or mid-aorta stenosis (MAS; 14.5%), heart failure (21.7%), and claudication (21.7%) were leading clinical hints for interventions. The technical success rate was 96.7%. During a median 2.88-year of follow-up after intervention, 36 lesions occurred with complications in 28 patients, and 22 lesions in 17 patients, particularly on the renal artery or mid-aorta. The 5-year complication-free and reintervention-free survivals were 50.7% and 65.8%, respectively. Peri-interventional dual antiplatelet therapy (DAPT; HR 0.31), concurrent surgery (HR 26.5), and technical failure (HR 3.65) were independent predictors for complications (P < 0.05). Male sex (HR 2.52), retinopathy secondary to hypertension (HR 3.41), and pulmonary artery hypertension (PAH; HR 3.64) were baseline indicators for complications (P < 0.05).
Over two-thirds of patients with childhood TAK require interventions, and the 5-year complication-free survival is 50.7%. Male sex, retinopathy, and PAH at baseline indicate the possibility of unfavorable outcomes. Interventions on MAS or RAS in childhood TAK raise specific concerns. DAPT peri-intervention appears to protect patients with childhood TAK from postinterventional complications.
针对儿童 Takayasu 动脉炎（TAK）的血管内治疗的循证研究有限。我们的目的是展示目前最大规模的儿童 TAK 患者接受介入治疗及其术后结果的真实情况。
收集了 2002 年至 2017 年期间入院的儿童 TAK 患者的数据。采用 Kaplan-Meier 方法预测并发症/再次干预无失败生存。通过回归模型评估介入治疗的相关因素和术后并发症/再次干预的预测因素。
在纳入的 101 例患者中，69 例（68.3%）在 3.1 年的随访中接受了 121 次介入治疗（血管成形术 95 次，支架置入术 26 次）。与非介入组相比，介入组与男性人群（比值比[OR]0.27，P=0.035）和 IV 型疾病（OR 17.92，P=0.001）独立相关。男性也预示着再次干预的风险（风险比[HR]3.22，P=0.05）。基线视网膜病变、诊断延迟和降主动脉受累与支架置入相关（P<0.05）。肾动脉狭窄（RAS；59.4%）或中主动脉狭窄（MAS；14.5%）、心力衰竭（21.7%）和跛行（21.7%）引起的高血压是介入治疗的主要临床指征。技术成功率为 96.7%。在介入治疗后中位数为 2.88 年的随访期间，28 例患者的 36 处病变出现并发症，17 例患者的 22 处病变出现并发症，特别是在肾动脉或中主动脉。5 年无并发症和无再次干预生存分别为 50.7%和 65.8%。围手术期双联抗血小板治疗（DAPT；HR0.31）、同期手术（HR26.5）和技术失败（HR3.65）是并发症的独立预测因素（P<0.05）。男性（HR2.52）、高血压引起的视网膜病变（HR3.41）和肺动脉高压（PAH；HR3.64）是基线并发症的指标（P<0.05）。
超过三分之二的儿童 TAK 患者需要介入治疗，5 年无并发症生存率为 50.7%。男性、基线时的视网膜病变和 PAH 提示可能出现不良结局。MAS 或 RAS 的介入治疗在儿童 TAK 中引起了特殊的关注。围手术期 DAPT 似乎可以保护儿童 TAK 患者免受术后并发症的影响。
