Abstract 706:  Intimal Hyperplasia in Temporal Artery Biopsy a Predictor for Neuro Opthalmic Complications of Giant Cell Arteritis?

Phil Seo

Authors

D. Makkuni, K. Wolfe, A. Hutchings, B. Dasgupta

Background

Blindness is the most feared complication of giant cell arteritis.  There is no good way, however, of determining which patients may be at highest risk.  This study examined whether the degree of intimal hyperplasia found in temporal artery biopsy correlated with cranial ischemic events (such as visual loss, anterior ischemic optic neuropathy, or cerebrovascular accident).

Methods

A single, blinded pathologist reviewed temporal artery biopsies from 30 patients with biopsy proven giant cell arteritis.  Each temporal artery biopsy was scored according to the severity of the blood vessel occlusion.  Grade 1 indicated the presence of less than 50% luminal occlusion, and grade 3 denoted the presence of more than 75% luminal occlusion due to intimal hyperplasia.  Odds ratios for cranial ischemic events were calculated using an age-adjusted logistic regression model.

Results

A total of 12 patients in this cohort suffered a cranial ischemic event.  One had a cerebrovascular accident, 10 had ocular complications, and 1 had both.  Of these 12 patients, 9 had grade 3 intimal hyperplasia.  The age adjusted odds ratio for visual symptoms was 20.8 (95% CI 2.6, 210) for each increase in the temporal artery biopsy grade. 

Conclusions

The presence of intimal hyperplasia on temporal artery biopsy correlates strongly with cranial ischemic events, and may be useful for identifying which patients are at highest risk of visual loss and cerebrovascular accidents.  

Editorial Comment

Cranial ischemic events, including blindness, are among the most feared complications of giant cell arteritis.  This study demonstrates that the temporal artery biopsy may be helpful in determining which patients are at greatest risk for these complications, and might benefit from more aggressive therapy.  From a practical standpoint, however, it is not clear how these data might be applied.  Typically, patients are started on empiric glucocorticoid therapy long before a temporal artery biopsy can be performed and interpreted by a pathologist.  Given that the risk of cranial ischemic events is likely greatest early in the course of the disease, it seems that in many cases the intimal hyperplasia score might be available only after therapeutic decisions have been made.  It would be interesting to know if doppler ultrasound might be a faster way to assess luminal diameter, and might allow early stratification of the patients at greatest risk.