Department of Neurology, Center for Mental and Neurological Disorders and Diseases, The Third Affiliated Hospital of Sun Yat-sen University, Guangzhou, China.
Department of Dermatology, Guangzhou Women and Children's Medical Center, Guangzhou, China.
Front Immunol. 2021 Apr 30;12:630619. doi: 10.3389/fimmu.2021.630619. eCollection 2021.
Takayasu arteritis (TA) is a chronic inflammatory disease involving the aorta and its principal branches. Acute ischaemic stroke (AIS) as the initial manifestation of TA is uncommon. There is little evidence on the efficacy of bridging therapy for AIS induced by TA. A 23-year-old Chinese woman with a suspected stroke presented to our hospital with sudden onset of right-sided weakness, right facial palsy, and aphasia that occurred 1 hour ago. After physical and ancillary examinations, recombinant tissue plasminogen activator was administered to the patient, which led to partial recovery. Her neurological function deteriorated with a large salvageable ischaemic penumbra on computed tomography perfusion. Cerebrovascular angiography showed multiple stenoses in the brachiocephalic trunk, the beginning of the right common carotid artery (CCA), and the bilateral subclavian arteries, as well as occlusion of the left CCA and its branches. Mechanical thrombectomy of the left middle cerebral artery was performed immediately. Percutaneous transluminal balloon angioplasty of the left CCA followed by stent implantation of the proximal left CCA was then performed. A diagnosis of TA was made based on the findings. The patient's neurological deficit fully recovered with immunosuppressants at the 3 month-follow-up. We report a rare case of a patient with TA initially presenting with AIS treated with bridging therapy with full recovery of neurological function. Bridging therapy should be taken into consideration for AIS in patients with TA. Further study is needed in this regard.
Takayasu 动脉炎（TA）是一种累及主动脉及其主要分支的慢性炎症性疾病。以急性缺血性脑卒中（AIS）为首发表现的 TA 并不常见。目前关于 TA 引起的 AIS 桥接治疗疗效的证据很少。一位 23 岁的中国女性因疑似中风到我院就诊，其突发右侧无力、右侧面瘫和失语，症状出现于 1 小时前。体格检查和辅助检查后，给予患者重组组织型纤溶酶原激活剂，患者症状部分恢复。但她的神经功能恶化，CT 灌注显示有大面积可挽救的缺血半影区。脑血管造影显示头臂干、右颈总动脉（CCA）起始部和双侧锁骨下动脉多处狭窄，左 CCA 及其分支闭塞。立即行左大脑中动脉机械取栓术，随后行左 CCA 经皮腔内血管成形术及近端左 CCA 支架植入术。根据检查结果诊断为 TA。患者在 3 个月随访时接受免疫抑制剂治疗后神经功能缺损完全恢复。我们报告了一例罕见的以 AIS 首发的 TA 患者，经桥接治疗后完全恢复了神经功能。对于 TA 患者的 AIS，应考虑桥接治疗。在这方面需要进一步研究。
