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Background/Purpose: In giant cell arteritis (GCA) and Takayasu arteritis (TA), strokes occur in approximately 7.4% and 15.8% of cases, respectively. Although these two large-vessel vasculitides share similarities, stroke presentation may differ in terms of clinical and radiological characteristics. This study aimed to compare the epidemiological, clinical, and prognostic features of stroke in patients with GCA and TA Methods: This was a multicenter retrospective cohort study conducted in France, including patients meeting the 2022 ACR/EULAR classification criteria for GCA and either the 2022 ACR/EULAR criteria or modified Ishikawa criteria for TA. Eligible patients had at least one stroke confirmed by imaging, occurring either at the time of or within 4 weeks of vasculitis flare. Results: A total of 108 patients (68 with GCA and 40 with TA) were analyzed. The female-to-male ratio was 0.78 in GCA and 5.2 in TA (p< 0.001). The mean age at stroke onset was 76+/-9 years in GCA and 35±10 years in TA (p< 0.001).
At the time of stroke, cardiovascular risk factors in GCA versus TA were as follows: overweight (22.4% vs. 10.3%, p=0.174), obesity (7% vs. 2.6%, p=0.645), smoking (40.9% vs. 39.4%, p=0.885), hypertension (64.7% vs. 32.4%, RR=1.99, p=0.003), dyslipidemia (36.8% vs. 8.8%, RR=4.2, p=0.002), and diabetes (14.7% vs. 2.9%, p=0.095).
Stroke occurred at the time of vasculitis diagnosis in 95.6% of GCA cases and 81.1% of TA cases (RR=1.18, p=0.031). All strokes were ischemic. The initial clinical presentation in GCA versus TA included motor deficits (47.1% vs. 30%, p=0.207), sensory deficits (14.7% vs. 16.7%, p=0.754), ophthalmologic symptoms (39.7% vs. 34.2%, p=0.677), cerebellar syndrome (29.4% vs. 0%, p=0.001), cranial nerve involvement (19.7% vs. 0%, p=0.017), language impairment (41.2% vs. 12.5%, RR=3.3, p=0.012), and neurosensory disturbances (55.9% vs. 18.4%, RR=3.04, p< 0.001).
Strokes involved the carotid territory in 35.3% of GCA cases and in 79.5% of TA cases (RR=0.44, p< 0.001) while the vertebrobasilar territory was involved in 75% of GCA cases and 20.5% of TA cases (RR=3.7, p< 0.001). Stroke recurrence occurred in 14.7% of GCA cases and 7.5% of TA cases (p=0.364), with a median recurrence time of 6 months (IQR: 1–10 months) after the initial stroke. Vascular surgery was required in 6% of GCA cases and 41% of TA cases (RR=0.14, p< 0.001). The mean follow-up duration was 5 ± 6.1 years, with mortality rates of 14.5% in GCA and 5% in TA (p=0.194). The survival curve for both groups is presented in Figure 1.
In multivariate analysis excluding age, independent factors associated with TA diagnosis were the absence of dyslipidemia (OR=0.085, p=0.035), carotid territory involvement (OR=13.7, p=0.003), and the need for vascular surgery (OR=10.6, p=0.009). Conclusion: Stroke presentation differs between GCA and TA. In GCA, strokes predominantly affect older individuals with cardiovascular risk factors and mainly involve the vertebrobasilar territory. While in TA, carotid involvement is more frequent and often necessitates vascular intervention. These clinical and prognostic differences are crucial for optimizing patient management
