Possibility of complex medicamental and endovascular treatment of pulmonary hypertension in Takayasu arteritis with predominant pulmonary arteries’ lesion

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Abstract

Takayasu arteritis (TA) is a systemic vasculitis with predominatly lesions of aorta and its large branches. In some cases pulmonary arteries (PA) are involved in the pathological inflammatory process and lead to the formation of pulmonary hypertension and significantly worse the prognosis. Timely development of lesion of PA, appointment of adequate therapy and surgical treatment can prevent irreversible damage of blood vessels and improve the prognosis. Perioperative administration of interleukin-6 inhibitor inhibitor (tocilizumab) in at patients with indications for vascular surgery, including angioplasty PA, should be considered as a promising approach to control the inflammatory activity of TA, reduce the dose of glucocorticoids and the risk of postoperative complications. We present the clinical experience of significant improvement in the patient’s condition was achieved by using two-stage balloon angioplasty on the background of control of the disease activity with interleukin-6 tocilizumab intravenously and specific therapy with riociguat and iloprost.

About the authors

T. V. Маrtynuk

National Medical Research Center for Cardiology

Author for correspondence.
Email: trukhiniv@mail.ru

д.м.н., рук. отд. легочной гипертензии и заболеваний сердца; проф. каф. кардиологии фак-та дополнительного профессионального образования 

Russian Federation, Moscow

A. M. Aleevskaya

National Medical Research Center for Cardiology

Email: trukhiniv@mail.ru

лаборант-исследователь отд. легочной гипертензии и заболеваний сердца

Russian Federation, Moscow

V. V. Gramovich

National Medical Research Center for Cardiology

Email: trukhiniv@mail.ru

к.м.н., ст. науч. сотр. отд. легочной гипертензии и заболеваний сердца

Russian Federation, Moscow

N. M. Danilov

National Medical Research Center for Cardiology

Email: trukhiniv@mail.ru

д.м.н., вед. науч. сотр. отд. гипертонии

Russian Federation, Moscow

I. Z. Korobkova

National Medical Research Center for Cardiology

Email: trukhiniv@mail.ru

к.м.н., зав. кабинетом рентгенографии

Russian Federation, Moscow

U. G. Matchin

National Medical Research Center for Cardiology

Email: trukhiniv@mail.ru

д.м.н., проф., рук. отд. рентгенэндоваскулярных методов диагностики и лечения в амбулаторных условиях

Russian Federation, Moscow

L. V. Solodovnikova

Mordovia Republican Central Clinical Hospital

Email: trukhiniv@mail.ru

врач-ревматолог

Russian Federation, Saransk

T. V. Beketova

Nasonova Research Institute of Rheumatology

Email: trukhiniv@mail.ru

д.м.н., проф., вед. науч. сотр. лаб. микроциркуляции и воспаления

 
Russian Federation, Moscow

References

  1. Jennette J, Falk R, Bacon P, et al. 2012 revised International Chapel Hill Consensus Conference Nomenclature of Vasculitides. Arthritis Rheum. 2013;65(1):1-11. doi: 10.1002/art.37715
  2. Hata A, Noda M, Moriwaki R, Numano F. Angiographic findings of Takayasu arteritis: new classification. Int J Cardiol. 1996;54(Suppl.):S155-63. doi: 10.1016/s0167-5273(96)02813-6
  3. Mwipatayi BP, Jeffery PC, Beningfield SJ, et al. Takayasu arteritis: clinical features and management: report of 272 cases. ANZJ Surg. 2005 Mar;75(3):110-7. doi: 10.1111/j.1445-2197.2005.03312.x
  4. Hayashi K, Nagasaki M, Matsunaga N, et al. Initial pulmonary artery involvement in Takayasu arteritis. Radiology. 1986;159:29-40. doi: 10.1148/radiology.159.2.3961173
  5. Brugiere O, Mal H, Sleiman C, et al. Isolated pulmonary arteries involvement in a patient with Takayasu’s arteritis. Eur Respir J. 1998;11:767-70. doi: 10.1183/09031936.98.11030767
  6. Sharma BK, Jain S, Suri S, Numano F. Diagnostic criteria for Takayasu arteritis. Int J Cardiol. 1996;54(Suppl.):S141-7.
  7. Toledano K, Guralnik L, Lorber A, et al. Pulmonary arteries involvement in Takayasu’s arteritis: two cases and literature review. Semin Arthritis Rheum. 2011 Dec;41(3):461-70. doi: 10.1016/j.semarthrit.2011.06.001
  8. Чазова И.Е., Мартынюк Т.В., Авдеев С.Н. и др. Клинические рекомендации по диагностике и лечению ЛГ. Евразийский кардиологический журн. 2014;4:4-24 [Chazova IE, Martynyuk TV, Avdeev SN, et al. Сlinical guidelines on diagnosis and treatment of pulmonary hypertension. Eurasian heart journal. 2014;4:4-24 (In Russ.)].
  9. Чазова И.Е., Мартынюк Т.В., Филиппов Е.В. и др. Клинические рекомендации по диагностике и лечению хронической тромбоэмболической легочной гипертензии (I часть). Терапевтический архив. 2016;88(9):90-101. [Chazova IE, Martynyuk TV, Filippov EV, et al. on behalf of the Working Group on Text Preparation for Russian Guidelines for the Diagnosis and Treatment of CTEPH. Clinical guidelines for the diagnosis and treatment of chronic thromboembolic pulmonary hypertension (Part 1). Therapeutic Archive. 2016;88(9):90-101 (In Russ.)].
  10. Brennan DN, Warrington KJ, Crowson CS, et al. Cardiopulmonary involvement in Takayasu’s arteritis. Clin Exp Rheumatol. 2018;2(36 Suppl. 111):46-50. PMID: 28628465
  11. Gong J, Yang Y, Ma Z, et al. Clinical and imaging manifestations of Takayasu’s arteritis with pulmonary hypertension: A retrospective cohort study in China. Int J Cardiol. 2018;276:224-9. doi: 10.1016/ j.ijcard.2018.08.047
  12. He Y, Lv N, Dang A, Cheng N. Pulmonary Artery Involvement in Patients with Takayasu Arteritis. J Rheumatol. 2019 May 15; pii: jrheum.190045. doi: 10.3899/jrheum.1900
  13. Hong S, Bae S, Ahn S, et al. Outcome of Takayasu arteritis with inactive disease at diagnosis: the extent of vascular involvement as a predictor of activation. J Rheumatol. 2015;42(3):489-94. doi: 10.3899/jrheum.140981
  14. Kong X, Sun Y, Ma L, et al. The critical role of IL-6 in the pathogenesis of Takayasu arteritis. Clin Exp Rheumatol. 2016;34(3 Suppl. 97):21-7.
  15. Бекетова Т.В., Насонов Е.Л. Инновационные методы лечения артериита Такаясу: в фокусе ингибиторы интерлейкина 6. Собственный опыт применения тоцилизумаба и обзор литературы. Научно-практическая ревматология. 2017;55(5):536-48 [Beketova TV, Naso- nov EL. Innovative treatments for takayasu’s arteritis: a focus on interleukin-6 inhibitors. the authors’ experience with tocilizumab and a review of literature. Rheumatology Science and Practice. 2017;55(5):536-48 (In Russ.)]. doi: 10.14412/1995-4484-2017-536-548
  16. Nakaoka Y, Higuchi K, Arita Y, et al. Tocilizumab for the treatment of patients with refractory Takayasu arteritis. Int Heart J. 2013;54:405-11. doi: 10.1536/ihj.54.405
  17. Nakaoka Y, Isobe M, Takei S, et al. Efficacy and safety of tocilizumab in patients with refractory Takayasu arteritis: results from a randomised, double-blind, placebo-controlled, phase 3 trial in Japan (the TAKT study). Ann Rheum Dis. 2018 Mar;77(3):348-54. doi: 10.1136/annrheumdis-2017-211878
  18. Humbert M, Coghlan JG, Ghofrani HA, et al. Riociguat for the treatment of pulmonary arterial hypertension associated with connective tissue disease: results from PATENT-1 and PATENT-2. Ann Rheum Dis. 2017 Feb;76(2):422-6. doi: 10.1136/annrheumdis-2015-209087. Epub 2016 Jul 25.
  19. Tyagi S, Mehta V, Kashyap R, Kaul UA. Endovascular stent implantation for severe pulmonary artery stenosis in aortoarteritis (Takayasu’s arteritis). Catheter Cardiovasc Interv. 2004 Feb;61(2):281-5.
  20. Данилов Н.М., Матчин Ю.Г., Мартынюк Т.В. и др. Транслюминальная баллонная ангиопластика легочных артерий у больных с неоперабельной хронической тромбоэмболической легочной гипертензией (первый опыт в России). Сonsilium Medicum. 2015;17(10):61-6 [Danilov NM, Matchin YuG, Martynyuk TV, et al. Transluminal balloon angioplasty of pulmonary arteries in patients with inoperable chronic thromboembolic pulmonary hypertension (first experience in Russia). Consilium Medicum. 2015;17(10):61-6 (In Russ.)].
  21. Qin L, Hong-Liang Z, et al. Percutaneous transluminal angioplasty and stenting for pulmonary stenosis due to Takayasu’s arteritis: clinical outcome and four-year follow-up. Clin Cardiol. 2009 Nov;32(11):639-43.

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