Evidence-based studies on endovascular approaches for childhood Takayasu arteritis(c-TA) are limited. This study presents the largest real-world scenario up-to-date for c-TA patients undergoing interventions and their post-interventional outcomes.
Data were collected for c-TA patients admitted from 2002 to 2017. Complication/Re-intervention-free survival were projected by Kaplan-Meier methods. Associated factors for intervention and predictors for post-interventional complications/re-interventions were assessed via regression models.
Among 101 patients enrolled, 69(68.3%) underwent 121 interventions(Angioplasty 95; Stenting 26) during 3.1-year follow-up. Compared with non-intervention group, the intervention group independently associated with male population(OR=0.27, p=0.035) and type IV disease(OR=17.92, p=0.001). Male sex also marginally indicated risk for re-intervention(HR=3.22,p=0.05). Baseline retinopathy, delay in diagnosis and descending thoracic aorta involvement 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%), claudication(21.7%) were leading clinical hints for interventions. Technical success rate was 96.7%. Over 2.88 years since intervention, 36 lesions occurred complications in 28 patients and 22 lesions in 17 patients, majorly on renal artery or mid-aorta. The 5-year complication-free and re-intervention survivals were 50.7% and 65.8%. 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 c-TA patients require interventions and 5-year complication-free survival is 50.7%. Male sex, retinopathy, and PAH at baseline alert unfavorable outcomes. Interventions on MAS or RAS in c-TA need specific concerns. DAPT peri-intervention appears to protect c-TA from post-interventional complications.
This article is protected by copyright. All rights reserved.