高安動脈炎

A 69-year-old female patient presented with a hypertensive emergency and recurrent episodes of left upper extremity paresthesia. While initial cerebrovascular imaging was negative, physical examination revealed a significant blood pressure discrepancy between the upper extremities. Subsequent computed tomography angiography of the abdomen identified abnormal circumferential wall thickening of the infrarenal abdominal aorta extending into the common iliac arteries, consistent with aortitis. Additionally, duplicate left renal arteries were noted, with severe stenosis of the posterior artery driving the hypertensive crisis. These findings supported a diagnosis of Type IV Takayasu arteritis, an exceptional presentation in a patient of advanced age with normal inflammatory markers. The patient was stabilized with intravenous antihypertensive therapy and transferred for multidisciplinary management. This case underscores the importance of considering large-vessel vasculitis in the differential diagnosis of elderly patients presenting with unexplained hypertensive emergencies, as reliance on age demographics or inflammatory markers may delay accurate diagnosis.

OBJECTIVE: Takayasu arteritis (TAK)-related stroke and large-artery atherosclerosis (LAA)-related stroke share overlapping clinical features but differ fundamentally in pathophysiology and treatment strategies. Differentiating these two aetiologies remains a diagnostic challenge with critical therapeutic implications. We aimed to compare the clinical profiles, imaging characteristics and outcomes of TAK- versus LAA-related stroke to provide insights for diagnosis and management. PATIENTS AND METHODS: We conducted a multicentre comparative study using nationwide prospective registry cohorts in China. Among 926 patients with TAK, 80 patients with stroke were included. In addition, 372 patients with LAA-related stroke were selected from the China National Stroke Registry-III cohort (n=14 146). Clinical and imaging characteristics, traditional stroke risk factors and outcomes were analysed and compared. Subgroup analyses were performed according to the presence of atherosclerosis in TAK. Propensity score weighting was performed as a sensitivity analysis. RESULTS: Compared with LAA-related stroke, TAK-related stroke was younger, with a strong female predominance and lower prevalence of vascular risk factors and appeared to have a higher proportion of favourable functional outcomes (modified Rankin Scale 0-2: 93.2% vs 72.6%, p=0.0002), although direct comparison was limited by differences in follow-up structure and assessment timing. Furthermore, patients with TAK tended to show distinct imaging features, including predominant extracranial artery involvement and anterior circulation infarctions located in the subcortical/deep white matter. Among patients with TAK-related stroke, those with coexisting atherosclerosis were older, had longer disease duration and had a greater risk of supra-aortic complications and a higher rate of endovascular interventions. CONCLUSIONS: This study highlights distinct clinical and imaging profiles between TAK- and LAA-related strokes. It also provides a comparative analysis of TAK-related stroke with and without atherosclerosis, revealing differences in risk factors, vascular characteristics and intervention needs. These findings provide a descriptive framework that may assist aetiological differentiation and hypothesis generation for future studies.

BACKGROUND: Abdominal aortic coarctation (AAC) is a rare cause of severe hypertension in adolescents and is often associated with Takayasu arteritis. CASE SUMMARY: We present a case of a 15-year-old boy with a 4-month history of progressive dyspnea and easy fatiguability. He was found to have severe systemic hypertension, radiofemoral delay, and a significantly higher upper limb blood pressure (BP) compared with lower limb BP. Computed tomography aortography demonstrated severe AAC. He underwent successful endovascular intervention with stenting of the abdominal aorta. Hypertension and symptoms resolved immediately postintervention. DISCUSSION: AAC may occur as a congenital anomaly or secondary to inflammatory conditions such as Takayasu arteritis, particularly in young individuals with severe hypertension. This case underscores the value of physical examination and imaging in the evaluation of a young patient with hypertension. TAKE-HOME MESSAGE: Severe hypertension with radiofemoral delay and an upper-to-lower limb BP gradient >20 mm Hg prompted evaluation for AAC.