LAUSR

A 17-year-old girl with a 1-month history of Takayasu arteritis had been referred for treatment of multiple stenotic lesions of the descending and abdominal aorta (figure 1A) and associated arterial hypertension (170/100 mmHg). She had been receiving oral prednisone and enalapril. Both erythrocyte sedimentation rate (ESR) and C-reactive protein (CRP) levels had been normal. Conventional angiography revealed a patchy narrowing of the descending and abdominal aorta (figure 1B). The celiac trunk was markedly stenotic at its origin, while the renal arteries were relatively spared (figure 2A). We decided to relieve the aortic stenosis by placing four overlapping bare stents (NuMed Inc., Hopkinton, NY, USA) measuring 45, 45, 39, and 34 mm in length over a 12 mm highpressure balloon catheter (figure 1C). This gave the appearance of a "reinforced aorta'' (figure 1D, supplementary Video 1). The aortic lumen significantly increased, and the peak systolic pressure gradient was reduced from 98 to 35 mmHg. The celiac trunk was dilated using a 4 mm high-pressure balloon catheter (figure 2B and C). The blood pressure decreased to 120/80 mmHg after the intervention. She was discharged on oral prednisone and aspirin.