scholarly journals Tocilizumab and Renal Artery Stent—Therapeutic Strategy for Takayasu Arteritis

2021 ◽  
pp. 1-4
Author(s):  
Srividhya Karunanithi ◽  
Subramanian Nallasivan ◽  
Mariappan Murugan
Keyword(s):  
Renal Artery ◽  
Takayasu Arteritis ◽  
Therapeutic Strategy ◽  
Transluminal Angioplasty ◽  
Obstetric Outcomes ◽  
Ct Angiogram ◽  
Renal Vessels ◽  
History Of ◽  
Abdominal Bruit ◽  
Percutaneous Transluminal

Takayasu vasculitis (TAK) is a form of large vessel vasculitis clinically manifesting as pulseless disease or hypertension. It is more common in South East Asia and Japan, India, and Mexico [1]. It is increasingly being recognized due to increased awareness among medical fraternity and better imaging modalities. Undetected hypertension, pulselessness, and syncope are more common symptoms and presentation during pregnancy is unusual and can lead to bad obstetric outcomes. Recent evidences support the use of tocilizumab for inducing remission in Takayasu arteritis. We report this rare case of vasculitis presenting in pregnancy as malignant hypertension. A 20-year-old pregnant woman (45 days) presented with headache and nausea but no fever. She had a history of intermittent claudication of legs for the past 3 years but not evaluated. During examination, pulses were felt normally and blood pressure (BP) 180/110, no murmurs in cardiac auscultation, but she had abdominal bruit (renal vessels). Other systems were normal. Echocardiogram (ECHO) showed dilated ascending aorta. Doppler of renal vessels showed narrowing of renal arteries. Unfortunately, she had to undergo termination of pregnancy (high BP in spite of antihypertensives). Her computed tomography (CT) angiogram showed features of TAK with type 5 pattern–she had methylprednisolone infusion 500 mg daily for 3 days, followed by injection tocilizumab 400 mg monthly 3 doses. Once remission was achieved, she had recanalization by percutaneous transluminal angioplasty of right renal artery. She is currently maintained on aspirin and telmisartan. Awareness of causes of high BP, inputs by radiologist, cardiologist, and rheumatologist and understanding by the patient and family helped to achieve good outcome albeit the miscarriage.

scholarly journals Stent angioplasti pada anak hipertensi akibat stenosis arteri renalis di RSUP dr. Kariadi

2019 ◽  
Vol 6 (2) ◽  
pp. 143-145
Author(s):  
Muhammad Heru Muryawan ◽  
Antonius Gunawan Santoso ◽  
Omega Mellyana
Keyword(s):  
Blood Pressure ◽  
Renal Artery ◽  
Percutaneous Transluminal Angioplasty ◽  
Secondary Hypertension ◽  
Good Prognosis ◽  
Transluminal Angioplasty ◽  
Stage Ii ◽  
Pediatric Hypertension ◽  
History Of ◽  
Percutaneous Transluminal

Background : Renal artery stenosis (RAS) causes 5-10% of all secondary hypertension (HT) in children. Percutaneous transluminal angioplasty (PTA) has proven beneficial for adult patients, but for a children there are varying result. This paper is to report the management of PTA in HT children due to RAS in Dr. Kariadi Hospital. Case report: Nine years 8 months boy with stage II HT since 4 years old, in a good nutritional status, complaints headaches, no family history of hypertension. Treatment with of nifedipine, captopril, valsartan and furosemide has not improved. Four months ago, the patient was treated by the Children's Nephrology and Radiology Division in Dr. Kariadi Hospital for 4 days. initial blood pressure 150/100 mmHg (stage II HT), normal eye examination, heart and kidney function, the angiographic results obtained severe right middle renal artery stenosis.teh stenosis reduced by PTA with dilated balloons up to 30%. One day after the procedure, blood pressure decreased to stage I HT, no complication involved, and the patient was discharged on day 4, with nifedipine, valsartan to control HT and aspilet as anti platelet aggregation. Evaluation 4 months after PTA obtained normal blood pressure. Discussion: HT renovascular children e.c. unilateral RAS performed by PTA has a good prognosis. Unilateral RASre-stenosis rates are less than 30%. Anti-hypertensive therapy is needed after ballooning or angioplasty stents. PTA in Dr. Kariadi Hospital can managed patient to make blood pressure normal. Conclusion: PTA management is an option in children with HT renovasculere.c SAR. Dr. Kariadi Hospital can be a referral  to manage the case. Keywords: pediatric hypertension, RAS, PTA, Dr. Kariadi Hospital   Latar belakang : Stenosis arteri renalis (SAR) menyebabkan 5-10%  dari seluruh hipertensi (HT) sekunder pada anak. Percutaneous transluminal angioplasty (PTA) terbukti bermanfaat untuk pasien dewasa, namun pada anak hasilnya bervariasi. Tujuan makalah ini melaporkan tatalaksana PTA pada anak HT akibat SAR di RSUP dr Kariadi. Laporan kasus : Anak laki laki 9 tahun 8 bulan dengan HTderajatII sejak usia 4 tahun, status gizi baik, keluhan kadang-2 sakit kepala, tidak ada riwayat keluarga hipertensi. Pengobatan nifedipin, kaptopril, valsartan dan furosemid belum membaik.  Empat bulan yang lalu pasien di rawat oleh Divisi Nefrologi Anak dan Radiologi di RSUP dr Kariadi selama 4 hari. Tekanan darah saat masuk 150/100 mmHg, pemeriksaan mata, fungsi ginjal dan jantung normal, Hasil angiografi didapatkan stenosis berat arteri renalis kanan pertengahan, dilanjutkan PTA dengan stent post dilatasi dengan balon, stenosis mejadi 30%. Satu hari paska tindakan, tekanan darah menurun menjadi HT derajat I, tidak ada kelainan dan dipulangkan pada hari ke 4, mendapat nifedipin, valsartan dan aspilet sebagai anti agregasi trombosit. Evaluasi 4 bulan paska PTA didapatkan tekanan darah normal. Pembahasan : HT renovaskuler anak e.c.SAR unilateral yang dilakukan PTA mempunyai prognosis baik. Angka re-stenosis SAR unilateral kurang dari 30%. Terapi anti-hipertensi diperlukan setelah pemasangan balon atau stent angioplasti. PTA di RSUP dr Kariadi berhasil membuat tekanan darah menjadi normal. Kesimpulan :Manajemen PTA merupakan pilihan pada anak dengan HT renovaskuler e.c SAR. RSUP dr Kariadi dapat menjadi rujukan dalam tatalaksana kasus tersebut. Kata kunci : hipertensi anak, SAR, PTA, RSUP dr Kariadi

Experience with Percutaneous Transluminal Angioplasty for Renal Artery Stenosis at The Cleveland Clinic

1988 ◽  
Vol 139 (3) ◽  
pp. 488-492 ◽  
Author(s):  
Joseph M. Hayes ◽  
Barbara Risius ◽  
Andrew C. Novick ◽  
Michael Geisinger ◽  
Margaret Zelch ◽  
...  
Keyword(s):  
Renal Artery ◽  
Renal Artery Stenosis ◽  
Percutaneous Transluminal Angioplasty ◽  
Cleveland Clinic ◽  
Transluminal Angioplasty ◽  
Artery Stenosis ◽  
Percutaneous Transluminal

Reconstruction of the renal artery after unsuccessful percutaneous transluminal angioplasty in children

1983 ◽  
Vol 145 (5) ◽  
pp. 647-651 ◽  
Author(s):  
Philip C. Guzzetta ◽  
Barry M. Potter ◽  
Sudesh Kapur ◽  
Edward J. Ruley ◽  
Judson Randolph
Keyword(s):  
Renal Artery ◽  
Percutaneous Transluminal Angioplasty ◽  
Transluminal Angioplasty ◽  
Percutaneous Transluminal

Successful transluminal angioplasty of renal arterial stenosis using the transcarotid approach

2002 ◽  
Vol 12 (6) ◽  
pp. 589-591 ◽  
Author(s):  
Kiyohiro Takigiku ◽  
Gengi Satomi ◽  
Satoshi Yasukochi
Keyword(s):  
Renal Artery ◽  
Renovascular Hypertension ◽  
Coronary Arteries ◽  
Percutaneous Transluminal Angioplasty ◽  
Transluminal Angioplasty ◽  
Left Ventricular ◽  
Arterial Stenosis ◽  
Left Renal Artery ◽  
Ventricular Failure ◽  
Percutaneous Transluminal

We successfully performed percutaneous transluminal angioplasty to treat severe renovascular hypertension with left ventricular failure in a 5-month-old infant. Using the transcarotid approach, we dilated the stenotic left renal artery without any difficulties, using progressively larger balloons designed for dilation of coronary arteries.

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