Page 307 - The Vasculitides, Volume 1: General Considerations and Systemic Vasculitis

Systemic Vasculitis of the Gastrointestinal Tract 281
Table 3. Ishikawa Criteria for Diagnosis of Takayasu Arteritis*

Criteria Definition

Three Major Criteria

1. Left mid subclavian artery The most severe stenosis or occlusion present in the mid

lesion portion from the point 1 cm proximal to the vertebral artery

orifice up to that 3 cm distal to the orifice determined by

angiography

2. Right mid subclavian artery The most severe stenosis or occlusion present in the mid

lesion portion from the right vertebral artery orifice to the point 3

cm distal to the orifice determined by angiography

3. Characteristic signs and These include limb claudication, pulselessness or pulse

symptoms of at least 1 month differences in the limbs, an unobtainable or significant blood

duration pressure difference (> 10 mmHg systolic blood pressure

difference in limb), fever, neck pain, transient amaurosis,

blurred vision, syncope, dyspnea or palpitations

Ten Minor Criteria

1. High ESR Unexplained persistent high ESR > 20 mm/hour

(Westergren) at diagnosis or presence of the evidence in
patient’s history

2. Carotid artery tenderness Unilateral or bilateral tenderness of common carotid arteries

on palpation. Neck muscle tenderness is unacceptable

3. Hypertension Persistent blood pressure > 140/90 mmHg brachial or >

160/90 popliteal

4. Aortic regurgitation or By auscultation, angiography or Doppler echocardiography.

annuloaortic ectasia By angiography or two-dimensional echocardiography

5. Pulmonary artery lesion Lobar or segmental arterial occlusion or equivalent

determined by angiography or perfusion scintigraphy, or

presence of stenosis, aneurysm, luminal irregularity or any

combination in pulmonary trunk or in unilateral or in

bilateral pulmonary arteries determined by angiography

6. Left mid common carotid Presence of the most severe stenosis or occlusion in the mid

lesion portion of 5 cm in length from the point 2 cm distal to its

orifice determined by angiography

7. Distal brachiocephalic trunk Presence of the most severe stenosis or occlusion in the

lesion distal third determined by angiography

8. Descending thoracic aorta Narrowing, dilatation or aneurysm, luminal irregularity or

lesion any combination determined by angiography. Tortuosity

alone is not acceptable

9. Abdominal aorta lesion Narrowing, dilatation or aneurysm, luminal irregularity or

aneurysm combination

10. Coronary artery lesion Documented on angiography below the age of 30 years in

the absence of risk factors like hyperlipidemia or diabetes

mellitus

The presence of two major, one major and three minor, or four minor criteria suggests a high

probability of TA.

*Adapted from [17].

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