This patient has severe Takayasu arteritis disease activity that has been difficult to control and she is currently on baricitinib, methotrexate and tacrolimus, having previously failed multiple other immunosuppressive agents. She has had multiple stent insertions for her left subclavian and left common carotid, and a bypass graft from her left subclavian to her right internal carotid. Given her refractory disease and recurrent in-stent stenoses, which correlate with her developing periodic cerebral hypoperfusion symptoms, this patient has had repeat angioplasties and these repeat angioplasties will likely form a significant part of her management moving forward.