VALVULAR AND STRUCTURAL HEART DISEASES
Stenting for middle aortic syndrome caused by Takayasu
arteritis-immediate and long-term outcomes
Wuqiang Che, MS*
Hongliang Xiong, MS*
Xiongjing Jiang, MD
Hui Dong, MD
Yubao Zou, MD
Yuejin Yang, MD, FACC
Runlin Gao, MD, FACC
Department of cardiology, Fuwai Hospital,
National Center for Cardiovascular Disease,
Chinese Academy of Medical Sciences and
Peking Union Medical College, Beijing,
Xiong-jing Jiang, MD, Department of Cardi-
ology, Fuwai Hospital, Chinese Academy of
Medical Sciences and Peking Union Medical
College, No. 167, Beilishi Rd., Xicheng Dis-
trict, Beijing 100037, China.
National Science Foundation for Young
Scientists of China, Grant/Award Number:
Objective: To evaluate immediate and long-term clinical outcomes of stenting for middle aortic
syndrome (MAS) caused by Takayasu arteritis (TA).
Background: Studies of endovascular stenting for the treatment of MAS caused by TA are scare.
Methods: Data from 48 consecutive TA patients (mean 33.3 6 12.6 years) with MAS treated by
stenting in our institution between January 2010 and July 2016 were collected and retrospectively
analyzed. Thirty-day and long-term follow-up clinical outcomes after aorta stenting were assessed.
Results: Stenting was successful in all patients. The mean stenosis and peak systolic pressure gra-
dient of aorta lesions were reduced from 81.3 6 8.0% and 70.7 6 18.4 mm Hg to 14.7 6 8.3% and
14.0 6 5.8 mm Hg immediately after the 54 stents were implanted. One patient developed retro-
peritoneal hemorrhage and one developed flow-limiting dissection that involved bilateral renal
arteries perioperatively. Both patients recovered without sequela. Compared with baseline, the
ankle brachial index (0.92 6 0.19 vs. 0.75 6 0.22), mean systolic blood pressure (149.5 6 19.1 vs.
179.0 6 28.4 mm Hg) and antihypertensive drugs (1.1 6 0.7 vs. 3.1 6 0.9) significantly improved
after an average follow-up of 3.1 years (all P < .001). A total of 5 (10.9%) patients developed
in-stent restenosis, which were resolved by reintervention (restenting in 3 patients and re-
angioplasty alone in 2 patients). No major adverse events occurred during follow up.
Conclusions: Percutaneous aortic stenting is highly efficacious and safe in treating patients with
MAS caused by TA with good immediate and long-term clinical outcomes.
hypertension, intermittent claudication, middle aortic syndrome, stents, Takayasu arteritis
Takayasu arteritis (TA) is a relatively uncommon chronic nonspecific
inflammatory disease of unknown etiology that mainly affects the aorta
and its major branches . The inflammatory process creates structural
changes that lead to wall thickening, fibrosis, and stenosis . Stenosis
is the most common vascular lesion of TA [3,4], and significant stenotic
lesions of the distal thoracic or abdominal aorta may result in middle
aortic syndrome (MAS) [5,6], which manifests as lower limb ischemia,
hypertension, myocardial hypertrophy, heart failure, hemorrhagic
stroke , or even death. Historically, the management of such lesions
involved with TA has been that of anti-inflammatory therapy and open
surgical techniques. However, the open surgical approach is technically
challenging due to its complexity with multiple vessel involvement and
is associated with high rates of procedural and periprocedural compli-
cations, such as postoperative anastomotic aneurysm formation, and
graft occlusion [7,8]. Due to these challenges, percutaneous translumi-
nal angioplasty (PTA) has gained popularity as the preferred treatment
method in suitable patients [9–11]. However, major concerns such as
*Wu-qiang Che and Hong-liang Xiong equally contributed to the study as
All authors take responsibility for all aspects of the reliability and freedom
from bias of the data presented and their discussed interpretation.
Catheter Cardiovasc Interv. 2018;91:623–631. wileyonlinelibrary.com/journal/ccd
2018 Wiley Periodicals, Inc.
Received: 21 November 2017
Accepted: 27 December 2017