High ischemic deficit in computed tomography perfusion is a risk factor for cerebral vascular ischemic events in Takayasu arteritis: a prospective observational study.

backgroundPatients suffering from Takayasu arteritis (TA) with stenosis or occlusion of supra-aortic trunks carry a high risk of cerebral vascular ischemic events (CVIEs). We explored the relationship between cerebral blood perfusion and CVIEs in TA.

methodsPatients with involvement of supra-aortic trunks undergoing computed tomographic perfusion (CTP) were enrolled. The primary endpoint was CVIEs. The secondary endpoint was a poor outcome (modified Rankin scale, mRS > 3). The relationship between CTP parameters, ischemic deficit (time to maximum, Tmax >6 s) and ischemic core (cerebral blood flow, CBF < 30%), CVIEs, and a poor outcome during follow-up was analyzed with Spearman correlation, Cox regression, cluster analysis, and Kaplan–Meier curves.

resultsEighty-one patients were enrolled. The median volume of the ischemic deficit was 2.5 (IQR 0–34.1) mL. The ischemic deficit was related to a previous ischemic stroke, abnormal vision, and vertebral-artery stenosis (all p < 0.05). During a median follow-up of 16.0 (IQR 3.0–29.0) months, 16 cases suffered CVIEs, including ischemic stroke (11 cases, 68.8%), ablepsia (six, 37.5%), death (three, 18.8%), other worsening cerebral ischemic symptoms (three, 18.8%). The CVIEs were independently associated with the ischemic deficit (hazard ratio, HR = 15.66[4.09–59.96], p < 0.001), hemoglobin (HR = 0.96[0.93–0.99], p = 0.003), and tocilizumab use (HR = 5.71[1.63–20.00], p < 0.001). The AUC of the ischemic deficit to predict CVIEs was 0.79 (95%CI = 62.07–95.62) at 1 year and 0.81 (95%CI = 0.65–0.96) at 3 years, respectively. Furthermore, patients could be clustered into three groups. Cluster 1 (inflammation type) and cluster 2 (non-inflammation type) shared a similar risk for CVIEs. Cluster 3 (inflammation with low-perfusion type) carried the highest risk for a CVIE (HR 35.21[4.63–267.58], p < 0.001) compared with cluster 1. Kaplan–Meier curves revealed that patients with high ischemic deficit or belonging to cluster 3 carried a higher risk of CVIEs or a poor outcome.

conclusionsThe high ischemic deficit is a risk factor for CVIEs in TA with involvement of supra-aortic trunks. Patients with inflammation and high ischemic deficit carry a high risk of suffering CVIEs and a poor outcome during follow-up. RETROSPECTIVELY REGISTERED.

trial registrationClinicalTrials.gov NCT03893136 REGISTRATION DATE: 2019-03-25.