Stroke and transient ischemic attack in Takayasu's arteritis : a systematic review and meta-analysis

© 2016 National Stroke Association. Published by Elsevier Inc. All rights reserved.Background: Cerebrovascular disease is one of the possible consequences of Takayasu’s arteritis (TA). However, little is known about the prevalence of stroke/transient ischemic attack (TIA) or its related clinical features among these patients. We have performed a systematic review and meta-analysis to estimate the rate and risk factors of stroke/TIA in TA as well as to explore associations with poorer outcomes. Methods: MEDLINE and Embase were searched (October 2014) for observational studies of any design reporting prevalence rates of stroke/TIA among TA patients. Study selection, data collection, and quality assessment were done independently. Studies’ results were pooled through random-effect metaanalysis. Heterogeneity was assessed with the I 2 test. Results: Twenty-one studies (16 studies were of cohort design) were included (n = 3269). The pooled stroke/ TIA prevalence rate estimate was 15.8% (95% confidence interval [CI]: 10.7%- 22.6%, I 2 = 94%). Sensitivity analysis, excluding 8 studies with poorer TA diagnostic criteria, yielded a similar estimate but without statistical heterogeneity (15.7%; 95% CI: 13.6%-18.1%, I 2 = 5.5%). Data were unavailable to explore possible associations between patients’ characteristics and stroke/TIA prevalence. Conclusion: Our results document a high prevalence of stroke/TIA among TA patients. However, there is scarce information on the type of stroke, the characteristics of the affected individuals, and stroke-associated morbidity and mortality. Future studies should aim to further explore this disabling complication to find the best treatment and prevention strategies.