Артериит Такаясу и инсульт
https://doi.org/10.14412/1996-7012-2026-3-78-83
Аннотация
Артериит Такаясу (АТ) – редкое воспалительное заболевание, которое поражает в первую очередь крупные и средние артерии. Клиническая картина характеризуется широким спектром проявлений, обычно на ранних стадиях заболевание протекает бессимптомно, позднее может прогрессировать до ишемических осложнений. Ишемические симптомы могут варьироваться в зависимости от пораженного сосуда. Неврологические проявления АТ разнообразны. Самым опасным из них является инсульт, который нередко служит основной причиной инвалидности и летального исхода у этих пациентов. Механизмы инсульта при АТ включают стеноокклюзирующие поражения интракраниальных или экстракраниальных сосудов вследствие артериального тромбоза и васкулита, аневризму, диссекцию сонной или позвоночной артерии, эмболию и др. В редких случаях АТ может осложняться геморрагическим инсультом на фоне аневризматического расширения сосудов головного мозга и/или артериальной гипертензии. Раннее выявление АТ у молодых пациентов с острыми нарушениями мозгового кровообращения имеет важное значение в клинической практике.
Об авторах
Н. В. Пизова
ФГБОУ ВО «Ярославский государственный медицинский университет» Минздрава России
Россия
Россия
Наталия Вячеславовна Пизова
150000, Ярославль, Революционная ул., 5
А. В. Пизов
ФГБОУ ВО «Ярославский государственный педагогический университет им. К.Д. Ушинского»
Россия
Россия
150000, Ярославль, Республиканская ул., 108/1
Литература
1. Насонов ЕЛ, редактор. Ревматология: клинические рекомендации. 2-е изд. Москва: ГЭОТАР-Медиа; 2020.
2. Moisii P, Jari I, Naum AG, et al. Takayasu's Arteritis: A Special Case Report and Review of the Literature. Medicina (Kaunas). 2024 Mar 9;60(3):456. doi: 10.3390/medicina60030456.
3. Watts R, Al-Taiar A, Mooney J, et al. The epidemiology of Takayasu arteritis in the UK. Rheumatology (Oxford). 2009 Aug;48(8): 1008-11. doi: 10.1093/rheumatology/kep153.
4. Toshihiko N. Current status of large and small vessel vasculitis in Japan. Int J Cardiol. 1996 Aug:54 Suppl:S91-8. doi: 10.1016/s0167-5273(96)88777-8.
5. Zaldivar Villon MLF, de la Rocha JAL, Espinoza LR. Takayasu arteritis: recent developments. Curr Rheumatol Rep. 2019 Jul 18; 21(9):45. doi: 10.1007/s11926-019-0848-3.
6. Arend WP, Michel BA, Bloch DA, et al. The ACR 1990 criteria for the classification of Takayasu’s arteritis. Arthritis Rheum. 1990 Aug; 33(8):1129-34. doi: 10.1002/art.1780330811.
7. Espinoza JL, Ai S, Matsumura I. New insights on the pathogenesis of Takayasu arteritis: revisiting the microbial theory. Pathogens. 2018 Sep 6;7(3):73. doi: 10.3390/pathogens 7030073.
8. Podgorska D, Podgorski R, Aebisher D, Dabrowski P. Takayasu arteritis – epidemiology, pathogenesis, diagnosis and treatment. J Appl Biomed. 2019 Mar;17(1):20. doi: 10.32725/jab.2018.005.
9. George MG. Risk factors for ischemic stroke in younger adults: a focused update. Stroke. 2020 Mar;51(3):729-735. doi: 10.1161/STROKEAHA.119.024156.
10. Ungprasert P, Wijarnpreecha K, Cheungpasitporn W, et al. Inpatient prevalence, burden and comorbidity of Takayasu’s arteritis: Nationwide inpatient sample 2013-2014. Semin Arthritis Rheum. 2019 Aug;49(1):136- 139. doi: 10.1016/j.semarthrit.2018.11.008.
11. Kerr GS, Hallahan CW, Giordano J, et al. Takayasu arteritis. Ann Intern Med. 1994 Jun 1;120(11):919-29. doi: 10.7326/0003-4819-120-11-199406010-00004.
12. Couture P, Chazal T, Rosso C, et al. Cerebrovascular events in Takayasu arteritis: a multicenter case-controlled study. J Neurol. 2018 Apr;265(4):757-763. doi: 10.1007/s00415-018-8744-8.
13. Goel R, Chandan JS, Thayakaran R, et al. Cardiovascular and Renal Morbidity in Takayasu Arteritis: A Population-Based Retrospective Cohort Study From the United Kingdom. Arthritis Rheumatol. 2021 Mar;73(3): 504-511. doi: 10.1002/art.41529. Epub 2021 Jan 22.
14. Ahn SS, Han M, Park YB, et al. Incidence, prevalence and risk of stroke in patients with Takayasu arteritis: A nationwide population-based study in South Korea. Stroke Vasc Neurol. 2022 Apr;7(2):149-157. doi: 10.1136/svn-2020-000809.
15. Duarte MM, Geraldes R, Sousa R, et al. Stroke and transient ischemic attack in takayasu’s arteritis: a systematic review and meta-analysis. J Stroke Cerebrovasc Dis. 2016 Apr;25(4):781-91. doi: 10.1016/j.jstrokecerebrovasdis.2015.12.005.
16. Kim H, Barra L. Ischemic complications in Takayasu’s arteritis: A meta-analysis. Semin Arthritis Rheum. 2018 Jun;47(6):900-906. doi: 10.1016/j.semarthrit.2017.11.001.
17. Held M, Sestan M, Kifer N, et al. Cerebrovascular involvement in systemic childhood vasculitides. Clin Rheumatol. 2023 Oct; 42(10):2733-2746. doi: 10.1007/s10067-023- 06552-5.
18. Hoffmann M, Corr P, Robbs J. Cerebrovascular findings in Takayasu disease. J Neuroimaging. 2000 Apr;10(2):84-90. doi: 10.1111/jon200010284.
19. Mirouse A, Deltour S, Leclercq D, et al. Cerebrovascular Ischemic Events in Patients With Takayasu Arteritis. Stroke. 2022 May; 53(5):1550-1557. doi: 10.1161/STROKEAHA. 121.034445.
20. de Paula LE, Alverne AR, Shinjo SK. Clinical and vascular features of Takayasu arteritis at the time of ischemic stroke. Acta Reumatol Port. 2013 Oct-Dec;38(4):248-51.
21. Arnaud L, Haroche J, Limal N, et al. Takayasu arteritis in France: A single-center retrospective study of 82 cases comparing white, North African, and black patients. Medicine (Baltimore). 2010 Jan;89(1):1-17. doi: 10.1097/MD.0b013e3181cba0a3.
22. Li-xin Z, Jun N, Shan G, et al. Neurological manifestations of Takayasu arteritis. Chin Med Sci J. 2011 Dec;26(4):227-30. doi: 10.1016/s1001-9294(12)60005-4.
23. Soto ME, Espinola N, Flores-Suarez LF, Reyes PA. Takayasu arteritis: Clinical features in 110 Mexican Mestizo patients and cardiovascular impact on survival and prognosis. Clin Exp Rheumatol. 2008 May-Jun;26(3 Suppl 49):S9-15.
24. Yang L, Zhang H, Jiang X, et al. Clinical Features and Outcomes of Takayasu Arteritis with Neurological Symptoms in China: A Retrospective Study. J Rheumatol. 2015 Oct;42(10): 1846-52. doi: 10.3899/jrheum.150097.
25. Hwang J, Kim SJ, Bang OY, et al. Ischemic stroke in Takayasu’s arteritis: Lesion patterns and possible mechanisms. J Clin Neurol. 2012 Jun;8(2):109-15. doi: 10.3988/jcn.2012.8.2.109.
26. Kong F, Huang X, Su L, et al. Risk factors for cerebral infarction in Takayasu arteritis: A single-centre case-control study. Rheumatology (Oxford). 2021 Dec 24;61(1):281-290. doi: 10.1093/rheumatology/keab308.
27. Misra DP, Rathore U, Mishra P, et al. Comparison of Presentation and Prognosis of Takayasu Arteritis with or without Stroke or Transient Ischemic Attack-A Retrospective Cohort Study. Life (Basel). 2022 Nov 16; 12(11):1904. doi: 10.3390/life12111904.
28. Zhang G, Ni J, Yang Y, et al. Clinical and vascular features of stroke in Takayasu's arteritis: A 24-year retrospective study. Rheumatol Immunol Res. 2023 Apr 18;4(1):22-29. doi: 10.2478/rir-2023-0004.
29. Hoffman GS. Takayasu arteritis: Lessons from the American National Institutes of Health experience. Int J Cardiol. 1996 Aug:54 Suppl:S99-102. doi: 10.1016/s0167-5273(96)88778-x.
30. Schreiber K, Sciascia S, de Groot PG, et al. Antiphospholipid syndrome. Nat Rev Dis Primers. 2018 Jan 11:4:17103. doi: 10.1038/nrdp.2017.103.
31. Jordan NP, Bezanahary H, D’Cruz DP. Increased risk of vascular complications in Takayasu’s arteritis patients with positive lupus anticoagulant. Scand J Rheumatol. 2015 May; 44(3):211-4. doi: 10.3109/03009742.2014.964305.
32. Bond KM, Nasr D, Lehman V, et al. Intracranial and Extracranial Neurovascular Manifestations of Takayasu Arteritis. AJNR Am J Neuroradiol. 2017 Apr;38(4):766-772. doi: 10.3174/ajnr.A5095.
33. Ringleb PA, Strittmatter EI, Loewer M, et al. Cerebrovascular manifestations of Takayasu arteritis in Europe. Rheumatology (Oxford). 2005 Aug;44(8):1012-5. doi: 10.1093/ rheumatology/keh664.
34. Cantu C, Pineda C, Barinagarrementeria F, et al. Noninvasive cerebrovascular assessment of Takayasu arteritis. Stroke. 2000 Sep;31(9): 2197-202. doi: 10.1161/01.str.31.9.2197.
35. Park BW, Park SJ, Park H, et al. Stenosis or occlusion of the right subclavian and common carotid arteries is more common than that of the innominate artery in Takayasu arteritis. Vasc Specialist Int. 2015 Dec;31(4): 120-4. doi: 10.5758/vsi.2015.31.4.120.
36. Kissin EY, Merkel PA. Diagnostic imaging in Takayasu arteritis. Curr Opin Rheumatol. 2004 Jan;16(1):31-7. doi: 10.1097/00002281-200401000-00007.
37. Schmidt WA, Nerenheim A, Seipelt E, et al. Diagnosis of early Takayasu arteritis with sonography. Rheumatology (Oxford). 2002 May; 41(5):496-502. doi: 10.1093/rheumatology/41.5.496.
38. Grayson PC, Ponte C, Suppiah R, et al. American College of Rheumatology/EULAR classification criteria for Takayasu arteritis. Ann Rheum Dis. 2022 Dec;81(12):1654-1660. doi: 10.1136/ard-2022-223482.
39. Samaan M, Abramyan A, Sundararajan S, et al. Cerebrovascular implications of takayasu arteritis: a review. Neuroradiology. 2025 Jan; 67(1):125-136. doi: 10.1007/s00234-024-03472-2.
40. Caso V, Paciaroni M, Parnetti L, et al. Stroke related to carotid artery dissection in a young patient with Takayasu arteritis, systemic lupus erythematosus and antiphospholipid antibody syndrome. Cerebrovasc Dis. 2002; 13(1):67-9. doi: 10.1159/000047749.
41. Geraldes R, Batista P, Pedro LM, et al. Takayasu arteritis presenting with internal carotid artery dissection. Cerebrovasc Dis. 2012;33(4):408-9. doi: 10.1159/000336243.
42. Herath HMMTB, Pahalagamage SP, Withana D, Senanayake S. Complete ophthalmoplegia, complete ptosis and dilated pupil due to internal carotid artery dissection: as the first manifestation of Takayasu arteritis. BMC Cardiovasc Disord. 2017 Jul 25;17(1):201. doi: 10.1186/s12872-017-0638-7.
43. Hao R, Zhang J, Ma Z, et al. Takayasu's arteritis presenting with common carotid artery dissection: A rare case report. Exp Ther Med. 2016 Dec;12(6):4061-4063. doi: 10.3892/etm.2016.3861.
44. Jang SY, Park TK, Kim DK. Survival and causes of death for Takayasu’s arteritis in Korea: A retrospective population-based study. Int J Rheum Dis. 2021 Jan;24(1):69-73. doi: 10.1111/1756-185X.14005.
45. Dai Y, Zhong Y, Jian B, et al. Bridging Therapy for Acute Stroke as the Initial Manifestation of Takayasu Arteritis: A Case Report and Review of Literature. Front Immunol. 2021 Apr 30:12:630619. doi: 10.3389/fimmu.2021.630619.
46. Fankhauser GT, Stone WM, Fowl RJ, et al. Surgical and medical management of extracranial carotid artery aneurysms. J Vasc Surg. 2015 Feb;61(2):389-93. doi: 10.1016/j.jvs.2014.07.092.
47. Oura K, Taguchi K, Yamaguchi Oura M, et al. Takayasu's Arteritis with a Thrombosed Aneurysm on the Common Carotid Artery Causing Ischemic Stroke. Intern Med. 2022 Feb 1;61(3):425-428. doi: 10.2169/internalmedicine.7735-21.
48. Tabata M, Kitagawa T, Saito T, et al. Extracranial carotid aneurysm in Takayasu's arteritis. J Vasc Surg. 2001 Oct;34(4):739-42. doi: 10.1067/mva.2001.116808.
49. Kim DS, Kim JK, Yoo DS, et al. Takayasu’s arteritis presented with subarachnoid hemorrhage: report of two cases. J Korean Med Sci. 2002 Oct;17(5):695-8. doi: 10.3346/jkms.2002.17.5.695.
50. Qi Y, Yang L, Zhang H, et al. The presentation and management of hypertension in a large cohort of Takayasu arteritis. Clin Rheumatol. 2018 Oct;37(10):2781-2788. doi: 10.1007/s10067-017-3947-4.
51. Wong SPY, Mok CC, Lau CS, et al. Clinical presentation, treatment and outcome of Takayasu’s arteritis in southern Chinese: A multicenter retrospective study. Rheumatol Int. 2018 Dec;38(12):2263-2270. doi: 10.1007/s00296-018-4150-x.
52. Sharma BK, Jain S, Radotra BD. An autopsy study of Takayasu arteritis in India. Int J Cardiol. 1998 Oct 1:66 Suppl 1:S85-90; discussion S91. doi: 10.1016/s0167-5273(98)00155-7.
53. Shuaib UA, Kate M, Homik J, Jerrakathil T. Recurrent non-aneurysmal subarachnoid haemorrhage in Takayasu arteritis: is the cause immunological or mechanical? BMJ Case Rep. 2013 Jun 13:2013:bcr2013008825. doi: 10.1136/bcr-2013-008825.
54. Joshi H, Allen J, Qiu D, et al. Spontaneous non-aneurysmal subarachnoid hemorrhage in Takayasu arteritis: a case implicating hyperperfusion and cerebral dysautoregulation. BJR Case Rep. 2019 Feb 1;5(2):20180113. doi: 10.1259/bjrcr.20180113.
55. Takayama K, Nakagawa H, Iwasaki S, et al. Multiple cerebral aneurysms associated with Takayasu arteritis successfully treated with coil embolization. Radiat Med. 2008 Jan; 26(1):33-8. doi: 10.1007/s11604-007-0184-9.
56. Егорова ОН, Тарасова ГМ, Койлубаева ГМ и др. Новая стратерия визуализации васкулитов крупных сосудов (по рекомендациям EULAR 2023 г.). Современная ревматология. 2023;17(6):122-127. doi:10.14412/1996-7012-2023-6-122-127.
57. Rathore U, Thakare DR, Patro P, et al. A systematic review of clinical and preclinical evidences for Janus kinase inhibitors in large vessel vasculitis. Clin Rheumatol. 2022 Jan; 41(1):33-44. doi: 10.1007/s10067-021-05973-4.
58. Misra DP, Rathore U, Patro P, et al. Corticosteroid monotherapy for the management of Takayasu arteritis-a systematic review and meta-analysis. Rheumatol Int. 2021 Oct;41(10): 1729-1742. doi: 10.1007/s00296-021-04958-5.
59. Misra DP, Rathore U, Patro P, et al. Disease-modifying anti-rheumatic drugs for the management of Takayasu arteritis – A systematic review and meta-analysis. Clin Rheumatol. 2021 Nov;40(11):4391-4416. doi: 10.1007/s10067-021-05743-2.
60. Misra DP, Wakhlu A, Agarwal V, Danda D. Recent advances in the management of Takayasu arteritis. Int J Rheum Dis. 2019 Jan:22 Suppl 1:60-68. doi: 10.1111/1756-185X.13285.
61. Егорова ОН, Тарасова ГМ, Койлубаева ГМ и др. Современные подходы к терапии артериита Такаясу. Современная ревматология. 2024;18(1):101-108. doi: 10.14412/1996-7012-2024-1-101-108.
62. Hunjul GNE, Cazzaniga J, Gonzalez JN, et al. A case of Takayasu's arteritis presenting with acute middle cerebral artery stroke managed with aortic-common carotid artery (CCA) bypass surgery. Cureus. 2023 Nov 2;15(11): e48166. doi: 10.7759/cureus.48166.
Рецензия
Для цитирования:
Пизова НВ, Пизов АВ. Артериит Такаясу и инсульт. Современная ревматология. 2026;20(3):78-83. https://doi.org/10.14412/1996-7012-2026-3-78-83
For citation:
Pizova NV, Pizov AV. Takayasu arteritis and stroke. Sovremennaya Revmatologiya=Modern Rheumatology Journal. 2026;20(3):78-83. (In Russ.) https://doi.org/10.14412/1996-7012-2026-3-78-83
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