Stroke characteristics in giant cell arteritis and Takayasu arteritis: A multicenter retrospective cohort study of 108 patients.

INTRODUCTION

Stroke is an uncommon but pivotal prognostic factor in giant cell arteritis (GCA) and Takayasu arteritis (TAK). While both conditions are large vessel vasculitis stroke characteristics may differ between them, with potential implications for diagnosis and acute management. This study aimed to compare the epidemiological, clinical, and prognostic features of stroke in GCA and TAK.

METHODS

We conducted a multicenter retrospective cohort study including patients who met the ACR/EULAR 2022 classification criteria for GCA or TAK and experienced at least one imaging-confirmed stroke. Patients with transient ischemic attacks, strokes occurring after the age of fifty in TAK, or strokes secondary to atrial fibrillation were excluded.

RESULTS

A total of 108 patients were analyzed (68 GCA, 40 TAK). The female-to-male ratio was 0.78 in GCA and 5.2 in TAK (p<0.001). Stroke occurred at a mean age of 75±12 years in GCA and 35±11 years in TAK (p<0.001). Hypertension (64.7% vs. 32.4%, p=0.003) and dyslipidemia (36.8% vs. 8.8%, p=0.002) were more frequent in GCA. Cerebellar syndrome (29.4% vs. 0%, p=0.001), cranial nerve involvement (19.7% vs. 0%, p=0.017), and sensory deficits (55.9% vs. 18.4%, p<0.001) were more frequent in GCA. Stroke involved the vertebrobasilar territory in 75% of GCA vs. 20.5% of TAK (p<0.001) and the carotid territory in 35.3% of GCA vs. 79.5% of TAK (p<0.001). Vascular intervention was required in 41% of TAK vs. 6% of GCA (p<0.001).

CONCLUSION

Stroke presentation differs between GCA and TAK, with predominant vertebrobasilar involvement in GCA. Carotid involvement is more frequent in TAK and often requires vascular procedures. These differences are crucial for appropriate management.