Outcomes of Vascular Interventions in Takayasu Arteritis and the Role of Biologic Therapy: A Multicenter Retrospective Study
Makaleler > Tam Makale · 2026
Yazarlar: Aysegul Avcu, Sema Kaymaz‐Tahra, Rıza Can Kardas, Fatma Basibuyuk, Ömer Uludağ, Duygu KERİM, Senar San, Hasan Kocaayan, Zeliha Ademoglu, Gokce Kenar Artin, Burak Ince, Hakan Emmungil, Servet Akar, Ayse Cefle, Ayten Yazici, Gokhan Keser, Kenan AKSU, Murat İnanc, Fatos Onen, Hamit Kucuk, Haner Direskeneli, Fatma Alibaz‐Oner
International Journal of Rheumatic Diseases, Uluslararası, Wos, 2026, cilt 29, ss e70724-e70724
Özet
OBJECTIVES: Takayasu arteritis (TAK) may lead to arterial stenosis/occlusion and aneurysms, occasionally requiring vascular interventions. We evaluated outcomes, restenosis, and complications after vascular interventions in TAK and explored factors associated with restenosis. METHODS: We retrospectively included TAK patients who underwent extracardiac endovascular or surgical vascular interventions before or after TAK diagnosis across eight tertiary centers (1995-2024). Indications, disease activity status at the time of intervention, procedural characteristics, early/late outcomes, major complications, and restenosis were recorded. Restenosis was defined as > 70% stenosis on follow-up imaging performed ≥ 3 months after the procedure. Restenosis analyses were restricted to steno-occlusive lesions. RESULTS: We included 119 patients with 201 treated lesions (185 steno-occlusive lesions; 16 aneurysms/dissections). Of all procedures, 61.2% (n = 123) were performed after TAK diagnosis under immunosuppressive therapy. Follow-up imaging was available for 170/185 steno-occlusive procedures, and restenosis status was evaluable in 168 procedures; restenosis occurred in 82/168 (48.8%) with a median time to restenosis of 19.5 months. In exploratory Kaplan-Meier analysis, 1-, 3-, and 5-year restenosis-free patency rates were 76.8%, 63.6%, and 56.5%, respectively. In analyses restricted to post-diagnosis steno-occlusive procedures, crude restenosis was significantly less frequent under biologic therapy than without biologic therapy (30.8% vs. 53.1%; Fisher's exact p = 0.040); however, biologic therapy was not associated with time to restenosis in Cox regression (HR 1.01, 95% CI 0.51-1.99; p = 0.97) or patient-clustered Cox analysis (HR 1.01, 95% CI 0.47-2.18; p = 0.98). Major complication rates were 3.9% for endovascular procedures and 12.5% for surgical procedures. Overall mortality was 11.8%, with two deaths attributed to procedure-related complications. CONCLUSIONS: Vascular interventions in selected patients with Takayasu arteritis were associated with acceptable major complication rates. Among post-diagnosis steno-occlusive procedures, biologic therapy was associated with lower restenosis rates in crude analyses; however, this association was not sustained after accounting for restenosis timing. Therefore, the potential role of biologic therapy in improving post-interventional vascular outcomes should be interpreted cautiously and requires confirmation in prospective studies with standardized imaging surveillance.