Ultrasound Examination of Carotid Arteries with Intima Media Measurement: An Underestimated Tool in the Diagnosis of Takayasu's Disease

The diagnosis of Takayasu's arteritis is often clinically difficult. The ultrasound examination of the arteries originating from the aortic arch, especially with the assessment of intima media thickness of common carotid arteries, is easily available and can add valuable information. Eighteen patients, 16 women and 2 men, aged 11–62, with established diagnosis of Takayasu's arteritis and 17 age- and sex-matched controls were examined using duplex color doppler ultrasound. The flow in subclavian, common, internal, external carotid and vertebral arteries was visualized. The mean intima media thickness of the common carotid arteries proximal to the bulb (CCA) and in the carotid bulb were measured in different planes, off-line from digitized images by a single reader, helped by a computerized system for averaging and analysis. A total occlusion of left common carotid arteries in three patients and right CCA in one patient was detected. An occlusion of the brachiocephalic trunk was found in one patient and significant narrowing found in two others. A significant (>-50%) stenosis or occlusion of at least one subclavian artery was present in a majority of patients (87%), with a predilection for the left subclavian artery. In 5 patients, a steal syndrome grade II or III was found in the vertebral arteries. The value of the mean IMT of the CCA is patients with Takayasu's disease was significantly higher than in controls (mean ± SEM; 1.1 ± 0.1 vs 0.59 ± 0.01 mm). In healthy controls, the intima media thickness of the bulb was higher than that in the CCA (0.7 ± 0.03 vs 0.59 ± 0.01 mm). In patients with Takayasu's disease, that proportion was inversed (0.81 ± 0.05 vs 1.1 ± 0.1 mm). Higher intima media thickness found in the common carotid artery than in the bulb can rise a suspicion of Takayasu's arteritis.