We evaluated the prevalence of intracranial arterial stenosis (ICAS) in Takayasu's arteritis (TA) patients to investigate the role of ICAS on the development of ischemic strokes.

TA is defined as granulomatous inflammation of the aorta and its major branches, and it has been recognized as uncommon cause of cerebral infarction in young age patients. However, ICAS has been reported as a cause of ischemic stroke in young patients with TA, still systematic studies about ICAS in TA patients is not yet sufficient.

We retrospectively reviewed medical charts, laboratory findings and evaluated neuroimaging of 153 TA patients who diagnosed as TA by the supra-aortic vascular imaging at Asan Medical Center, South Korea, between January 2005 and December 2017. The recruited patients were classified according to the presence of history of acute ischemic stroke or TIA. All images were analyzed independently by two experienced reviewers who were blinded to the patients’ clinical condition.

Among 153 TA patients, 32 patients (20.8%) were classified into stroke group. ICAS was identified in 10.4% (n=16) of total TA patients and located mainly at middle cerebral artery (10 of 16, 62.5%). Stroke group had significantly higher prevalence of ICAS (11 of 32, 34.3%) than non-acute stroke group 5 of 121, 4.1%) (p<0.001). Among 9 TA patients who had both ischemic stroke and ICAS, 6 cases showed ICAS as culprit lesion of the ischemic stroke. Regarding classical atherosclerotic risk factors, the rate of hypertension (75.0 % vs. 47.1%), diabetes (9.4% vs. 5.0%), and smoking (21.9% vs. 5.0%) were higher in stroke group than non-stroke group. Among these factors, the rate of hypertension (p=0.009) and smoking (p=0.007) had statistical significance.

ICAS is not an uncommon finding in TA patients and more likely to exist in TA patients with acute stroke than non-acute stroke patients with statistical significance.