Cerebrovascular accidents in giant cell arteritis: prevalence and predictive factors from the ARTESER registry
Authors: Martín-Gutiérrez Adrián , Molina-Collada Juan , Domínguez-Álvaro Marta , Melero-González Rafael B , Fernández-Fernández Elisa , Silva-Díaz Maite , Valero Jesús Alejandro , González Ismael , Martín Julio Sánchez , Narváez Javier , Calvo Itziar , Aldasoro Vicente , Abasolo Alcázar Lydia , Loricera Javier , Ruíz-Roman Alberto , Castañeda Santos , Molina-Almela Clara , Alcalde Villar María , Juan Mas Antonio , Blanco Ricardo ,   ARTESER Project Collaborative Group, Morales Clara Moriano , Álvarez Elvira Díez , Sandoval Trinidad Pérez , Mendizábal Javier , Manteca María Concepción Fito , del Val del Amo Natividad , Rubio Loreto Horcada , Zudaire Inmaculada Paniagua , Courel Laura Garrido , Polo Ricardo Gutiérrez , Vélez Juliana Restrepo , Cortina Eduardo Loza , Hidalgo Tomás Almorza , Carreira Patricia , Mateos Leticia Léon , Rodríguez Luis Rodríguez , Urgelles Judit Font , Bermejo Pia Mercedes Lois , Gutiérrez Benjamin Fernández , Monte Tarek Salman , Arrabal Selene Labrada , Frutos Anne Riveros , Casafont Ivette , Pérez Susana Holgado , Camins Jordi , Fernández Cristina Campos , Cid Amalia Rueda , Catalá Javier Calvo , Rodríguez Iñigo Hernández , Maceiras Francisco , Pérez Nair , Barbazán Ceferino , Pego Jose María , Altabás Irena , Guzman John , Estrada Paula Valentina , Angeles Vanessa Andrea Navarro , Moya Patricia , Corominas Hector , Castellví Iván , Magallares Berta , Millán Ana Milena , Valenciano Ana F Cruz , Pozo Félix Cabero del , Cambrón Ana Belén Rodríguez , Villa Cristina Macia , Andrés Eva Álvarez de , Vilamajó Inmaculada Ros , Barcelo Monica Ibáñez , Toniolo Elide , Cacheda Ana Paula , Reyes María Sagrario Bustabad , González María García , Dorta Alicia García , Hernández Vanesa Hernández , Rocha Margarida Vasques , Allen Jaime Calvo , Mendieta Eugenio de Miguel , Henri Irene Monjo , Uriarte-Ecenarro Miren , Martínez Cristina Valero , Rabaneda Esther F Vicente , Porrúa Carlos García , Ubiaga Carlota Laura Iñiguez , Rivas Noelia Álvarez , Rodríguez Tomás Ramón Vázquez , Filloy Jose Alberto Miranda , Fernández Amalia Sánchez-Andrade , González-Gay Miguel Ángel , Da Veiga Carlos Galisteo Lencastre , Fontova Joan Calvet , Villanueva María Jesús García , Grijalba Carmen Larena , Cabañas Marina Tortosa , Álvarez Patricia Morán , Warleta Marta Serrano , Vargas Aliuska Palomeque , Garrido Noemí , Cros Clara Aguilera , Jimenez Alejandro Muñoz , Sanjuán Francisco Ortiz , Ivorra Jose A Román , Bárcena Carmen Riesco , Huaylla Anderson , Agirregoikoa Eva Galíndez , Lluch Judit , Belzunegui Joaquín María , Domínguez Luis López , Dubuc Cesar Antonio Egues , Fernández Lucia Silva 
Published: February 2025

Abstract

Objective
To determine the prevalence and predictive factors of cerebrovascular accidents (CVA) in GCA.

Methods
ARTESER is a large Spanish multicentre registry including patients with GCA from across the entire country diagnosed between June 2013 and March 2019 and sponsored by the Spanish Society of Rheumatology. The variables collected at diagnosis were demographics, clinical manifestations (including the occurrence and location of CVA), laboratory, histology and imaging findings. Patients with and without CVA were compared in a bivariate analysis. Multivariate logistic regression was performed to determine potential predictive factors of CVA.

Results
A total of 1540 patients with GCA were included for analysis (mean age 77.1 years, 70% females). CVA occurred in 61 (3.96%), of whom 38 (62.3%) involved the vertebrobasilar territory and 21 (34.4%) the carotid territory. The factors associated with CVA were the occurrence of transient ischaemic attack (TIA) [odds ratio (OR) 8.63; 95% CI 2.877–25.86], large vessel (LV) involvement (OR 2.79; 95% CI 1.421–5.465) and the presence of concomitant visual manifestations (OR 2.73; 95% CI 1.427–5.235). The risk of death during follow-up was significantly higher in patients with CVA (18% vs 8.8%; P = 0.014). Patients with CVA received significantly higher mean prednisone (mg) dose at diagnosis (433.9 vs 216; P &lt; 0.001) and cumulative prednisone dose during follow-up (11 203.9 vs 8,194.1; P &lt; 0.001).

Conclusion
The prevalence of CVA in patients with GCA is low, but increases the risk of mortality. The presence of TIA, LV involvement and visual manifestations are factors associated with increased risk of CVA.