Takayasu Arteritis Presenting with Internal Carotid Artery Dissection

Discussion Our patient fulfills all the American College of Rheumatology criteria for TA [5] , and vessel vasculitis was histologically proven. Arterial dissection in TA is rare [2, 6] , with few reports of aortic dissection [7] and only one report of ICA dissection [8] . In our patient, at the moment of ICA dissection, all the other aortic archs and their branches were angiographically normal and the laboratory tests unremarkable. Extension of arteritis in TA seems to occur in a symmetric way to the paired vascular beds and contiguously in the aortic arch, brachiocephalic trunk and the aorta [1] . Iliac occlusion is an uncommon complication of TA [2, 3] . Our case, with initial ICA and external iliac artery involvement, is atypical but clearly evolved to a typical TA. Large-vessel vasculitis is not in the differentials of ICA dissection [9] ; however, ICA dissection can be the first manifestation of TA and is another possible mechanism of cerebrovascular ischemia in TA. Background In Takayasu arteritis (TA), vessel wall thickening and stenosis are the most common findings, whereas aneurysmal dilatations occur less frequently [1, 2] and arterial dissection is rare. Cerebral ischemia may occur in up to 16% of the patients with TA [3] and can be due to several mechanisms such as subclavian steal in the arm, vessel stenosis/occlusion and embolism from the aorta or the heart [4] .