Patients with Takayasu arteritis combined with aortic valve disease often have a poor prognosis following surgical valve replacement, frequently encountering complications such as perivalvular leakage, valve detachment, and anastomotic aneurysm. This article presents a high-risk case wherein severe aortic valve insufficiency associated with Takayasu arteritis was successfully managed through transcatheter aortic valve implantation via the transapical approach. The patient had satisfactory valve function with no complications observed during the six-month postoperative follow-up period. This case provides a minimally invasive and feasible alternative for the clinical management of such high-risk patients.
Objective To observe the peripapillary choroidal thicknesses (pCT) and subfoveal choroidal thicknesses (SFCT) of nonarteritic anterior ischemic optic neuropathy (NAION). Methods Forty-four Chinese patients with unilateral NAION were recruited and compared with 60 eyes of 60 normal age and refractive-error matched control subjects. pCT and SFCT were measured by enhanced depth imaging optical coherence tomography. Choroidal thicknesses of eyes with NAION and unaffected fellow eyes were compared with normal controls. Choroidal thicknesses of NAION eyes with or without optic disc edema were also compared. The correlation between choroidal thickness and retinal nerve fiber layer (RNFL) thickness, logarithm of the minimum angle of resolution (logMAR) best-corrected visual acuity (BCVA), and the mean deviation (MD) of Humphrey static perimetry in NAION eyes were analyzed. Results The pCT at the nasal, nasal inferior and temporal inferior quadrants in NAION eyes with optic disc edema were significantly thicker than that of normal subjects (t=3.152, 3.166, 2.808; P＜0.05). There was no significant difference in the choroidal thicknesses between the unaffected fellow eyes of NAION patients and normal eyes of healthy controls; or between the NAION eyes with resolved optic disc edema and normal eyes (P＞0.05). No significant correlation between choroidal thickness (r=－0.220, －0.140, 0.110), SFCT (r=0.096, －0.148, －0.131) and logMAR BCVA, perimetry MD and RNFL was found in eyes affected by NAION (P＞0.05). Conclusions The peripapillary choroidal thicknesses increase in some quadrants in NAION eyes with optic disc edema. However, the choroidal thickness of NAION eyes is the same in age and refractive error-matched normal subjects.
Objective To observed and analyze the clinical features of patients with nonarteritic anterior ischemic optic neuropathy (NAION) causes of misdiagnosis. MethodsA retrospective case study. From November 2014 to July 2022, 49 NAION patients with 49 eyes diagnosed in Department of Ophthalmology, The First People’s Hospital of Lanzhou were included in the study. All patients were misdiagnosed with other eye diseases at first diagnosis. All eyes were examined by best corrected visual acuity (BCVA), relative afferent pupil defect (RAPD), orbital magnetic resonance imaging (MRI), visual field, optical coherence tomography (OCT), and graphic visual evoked potential (P-VEP). Fluorescein fundus angiography (FFA) was performed in 32 eyes. Clinical and MRI, visual field, P-VEP、FFA features of the patients were retrospectively analyzed. ResultsThere were 31 males and 18 females among the 49 patients. All cases were monocular. Age was (59.3±7.8) years. All of them complained of painless visual acuity loss or occlusion sensation in one eye. There were 12 (24.5%, 12/49) and 37 (75.6%, 37/49) cases with disease duration ＞2 months and ≤2 months, respectively. In 49 eyes, misdiagnosed as optic neuritis, normal tension glaucoma (NTG) or suspected glaucoma, optic disc vasculitis, cataract, diabetic retinopathy, traumatic optic neuropathy and toxic optic neuropathy were 28 (57.1%, 28/49), 11 (22.4%, 11/49), 5 (10.2%, 5/49), 2 (4.1%, 2/49), 1 (2.0%, 1/49), 1 (2.0%, 1/49), 1 (2.0%, 1/49) eyes. 24 (49.0%, 24/49), 16 (32.7%, 16/49) and 9 (18.4%, 9/49) eyes had BCVA＜0.1, 0.1-0.5 and＞0.5, respectively. RAPD was positive in 45 eyes (91.8%, 45/49). There were 37 (75.6%, 37/49) and 12 (24.5%, 12/49) eyes with and without optic disc edema, respectively. Bleeding was observed on and around the optic disc in 15 eyes (30.6%, 15/49). MRI examination showed no obvious abnormality in the optic nerve segments of all affected eyes. OCT showed an increase in retinal nerve fiber layer thickness (307.1±62.1) μm in 37 patients with optic disc edema. The visual field examination showed that 24 eyes (49.0%, 24/49) had typical lower visual field defect connected with the physiological blind spot and circumvented the central fixation point, 6 eyes (12.2%, 6/49) had limited visual field defect connected with the physiological blind spot, and 19 eyes (38.8%, 19/49) had diffuse visual field defect. By P-VEP examination, the amplitude of P100 wave decreased moderately to severely in all affected eyes. There were 24 eyes (49.0%, 24/49) with mild peak delay and 11 eyes (22.4%, 11/49) with moderate peak delay. In 32 eyes examined by FFA, the arteries had early peridisk limitation or diffuse delayed filling, and mid-course fluorescein leakage in the corresponding area. ConclusionsThe main symptoms of NAION patients are painless visual acuity loss in one eye or occlusion of vision. The main clinical features of NAION patients are visual field defect, retinal nerve fiber layer thickening and visual electrophysiological abnormalities. NAION patients with acute or subacute visual loss accompanied by optic disc edema and/or bleeding are often misdiagnosed as optic neuritis, optic neurovasculitis and other types of optic neuropathy. NAION patients with a disease course of ＞2 months are easily misdiagnosed as NTG.
ObjectiveTo investigate the relationship between the level of stromal cell-derived factor-1 (SDF-1), internal carotid artery stiffness index, and non-arteritic anterior ischemic optic neuropathy (NAION) with macular edema (ME). MethodsA retrospective study. A total of 202 patients with NAION diagnosed by ophthalmic examination in Department of Ophthalmology, The Second Affiliated Hospital of Jiamusi University from January 2023 to January 2025 were included in the study. Based on the presence or absence of ME, the patients were divided into the NAION+ME group and the NAION group, with 94 and 108 cases respectively. A prediction model was constructed based on the influencing factors. To comprehensively evaluate the predictive value of SDF-1 level and carotid artery stiffness index for NAION with ME, a multidimensional analytical approach was employed. The diagnostic performance of individual and combined markers was assessed by constructing receiver operating characteristic (ROC) curves and calculating the area under the curve (AUC). Multivariate logistic regression analysis was performed to determine their independent predictive value. Stratified subgroup analyses were conducted to explore predictive differences across various populations. Cox proportional hazards regression models were established to evaluate long-term predictive value. Restricted cubic spline (RCS) analysis was applied to reveal potential nonlinear dose-response relationships. Mediation effect models were constructed to analyze the mediating role of carotid artery stiffness index in the association between SDF-1 level and NAION with ME. ResultsIn the NAION+ME group, systolic blood pressure (t=6.066), body mass index (t=2.804), disease duration (t=2.552), intraocular pressure (t=2.574), high-density lipoprotein (t=2.729), fasting blood glucose (t=2.022), glycosylated hemoglobin (t=7.235), SDF-1 level (t=14.319), and internal carotid artery stiffness index (t=2.633) were higher than those in the NAION group, while diastolic blood pressure was lower (P＜0.05). ROC curve analysis showed that the AUC of SDF-1 level combined with internal carotid artery stiffness index in predicting the risk of adverse prognosis was 0.894 [95% confidence interval (CI) 0.803-0.945], with a sensitivity of 87.98% and a specificity of 95.69%. Logistic regression analysis demonstrated significant independent correlations between SDF-1 level (OR=1.682, 95%CI 1.156-1.986), internal carotid artery stiffness index (OR=1.826, 95%CI 1.369-2.648), and the risk of ME in NAION patients (P＜0.05). Subgroup analysis revealed that elevated SDF-1 level and internal carotid artery stiffness index were associated with a higher risk of NAION with ME (Pfor trend＜0.05). RCS analysis demonstrated a nonlinear dose-response relationship between the continuous changes in SDF-1 level and internal carotid artery stiffness index and the risk of NAION with ME (P＜0.05). Mediation effect model analysis showed that internal carotid artery stiffness index played a mediating role between SDF-1 level and the risk of NAION with ME. ConclusionsSDF-1 level and internal carotid artery stiffness index are independent risk factors for ME in NAION patients. The combined detection of these two indicators holds significant value in predicting disease progression.
目的 总结盐酸沙格雷酯治疗周围动脉炎性疾病的初步疗效。方法 2009年10月至2012年3月期间我院共收治32例周围动脉炎性疾病患者，其中血栓闭塞性脉管炎（TAO） 18例，雷诺综合征14例，经患者知情同意的情况下给予盐酸沙格雷酯治疗，给予西络他唑100mg/d以及必须的强的松治疗后加服盐酸沙格雷酯100mg，3次/d口服，治疗后3个月观察疗效。结果 18例TAO患者中有10例服用了盐酸沙格雷酯，治疗后其间歇性跛行距离〔（362±127） m〕较治疗前 〔（224±86） m〕延长；8例静息痛患者中7例症状消失，1例改善；4例溃疡患者中3例愈合，1例未愈合。8例未加服盐酸沙格雷酯患者，有6例间歇性跛行消失，2例改善；5例静息痛患者中3例症状消失，2例改善；2例溃疡患者中1例愈合，1例未愈合。14例雷诺综合征患者中8例加服盐酸沙格雷酯，雷诺症状7例消失，1例改善；3例溃疡患者完全愈合。6例未加服盐酸沙格雷酯患者雷诺症状4例消失，2例改善；1例溃疡患者未愈合。结论 从本组有限病例资料看，盐酸沙格雷酯对于治疗周围动脉炎性疾病是有效的。
ObjectiveTo study the clinical safety and effectiveness of paclitaxel-drug coated balloon (DCB) in treatment of Takayasu’s arteritis (TA) of renal artery. MethodsThe retrospective analysis was made on the clinical data of the three patients with severe stenosis of renal artery, who were treated in our hospital from January 2019 to August 2023. The patients underwent paclitaxel-DCB dilation therapy. ResultsSuccessful treatment was accomplished in all the three patients. The patients were followed up for 17, 38, and 40 months respectively, follow-up examination of ultrasound showed that the blood flow in renal artery was unobstructed. The serum creatinine level was changed from preoperative 53, 64, 55 μmol/L to 43, 70, 59 μmol/L on postoperative day 1. The systolic blood pressure was decreased from preoperative 180, 220, 150 mmHg to 116, 120, 110 mmHg on postoperative day 1. The peak systolic velocity of renal artery was reduced from preoperative 350, 377, 293 cm/s to 120, 135, 94 cm/s on postoperative day 1. ConclusionPaclitaxel-DCB is safe and effective for patients with renal artery stenosis of TA, but further researches with large sample are still needed.
ObjectiveTo enhance the understanding of Takayasu’s arteritis (TA) with pulmonary vascular involvement through the analyses on clinical features.MethodsA retrospective study was conducted to analyze the clinical records of patients diagnosed as TA with pulmonary vascular involvement admitted to Beijing Anzhen Hospital from January 2007 to August 2017.ResultsIn recent 10 years, there were 233 patients diagnosed as TA in Beijing Anzhen Hospital, 17 of them were involved with pulmonary arterial, which accounted for 7.3%. Fourteen patients were females, 3 patients were males. The age ranged from 16 to 59 years with an average of (40±13) years. Among the 17 patients, dyspnea (15 cases, 88.2%) was the most common symptom, and unequal blood pressure of upper limbs (9 cases, 52.9%) was the main sign. Thirteen patients had pulmonary hypertension by echocardiographic examination. Angiographic data showed that multi-lobular and multi-segmental pulmonary branches were predominantly affected. Unilateral involvement of pulmonary artery was more common than bilateral involvement, while the right pulmonary arteries were more often affected than the left. Thirteen patients received hormone and immunosuppressive therapy, 11 patients received anticoagulation or antiplatelet therapy, and 5 patients received targeted treatment of pulmonary artery pressure.ConclusionsThe clinical manifestation of TA is unspecific and misdiagnosis rate is relatively high. Improving the understanding of TA is necessary so as to reduce the misdiagnosis rate at an early stage and ameliorate the prognosis.