Acute myocardial infarction with left main coronary artery ostial negative remodelling as the first manifestation of Takayasu arteritis: a case report

Abstract

Background Takayasu arteritis is a chronic inflammatory disease involving the aorta and its major branches. Acute myocardial infarction rarely but not so much presents in patients with Takayasu arteritis, and the preferable revascularization strategy is still under debate. Case presentation A 22-year-old female with Takayasu arteritis presented with acute myocardial infarction. Coronary angiography and intravenous ultrasound (IVUS) showed that the right coronary artery (RCA) was occluded and that there was severe negative remodelling at the ostium of the left main coronary artery (LMCA). The patient was treated by primary percutaneous transluminal coronary angioplasty (PTCA) with a scoring balloon in the LMCA, without stent implantation. After 3 months of immunosuppressive medication, the patient received RCA revascularization by stenting. There was progressive external elastic membrane (EEM) enlargement of the LMCA ostium demonstrated by IVUS at 3 and 15 months post-initial PTCA. Conclusion Here, we report a case of Takayasu arteritis with involvement of the coronary artery ostium. Through PTCA and long-term immunosuppressive medication, we found that coronary negative remodelling might be reversible in patients with Takayasu arteritis.

Coronary artery lesions in Takayasu arteritis

“…Intravascular US helps determine changes in the structure of the coronary artery wall and the presence of atherosclerotic plaques in coronary arteries [ 51 ]. Ishiyama et al [ 52 ] reported that IVUS showed that the three-layered structure of the intima, tunica media, and adventitia was not visible, and the vessel was concentrically thickened; unstable plaque and calcification were not seen.…”

“…Additionally, Sun et al [ 14 ] observed a history of MI in 8.9% of 15 patients. It is worth noting that MI can be the initial manifestation of TAK [ 41 , 51 ].…”

Clinical and vascular lesion characteristics of the patients with takayasu arteritis manifested firstly as acute myocardial infarction at onset

“…The proportion of coronary arteries involvement in patients with TA is about 9–10% [ 1 , 4 , 5 , 14 , 24 ]. TA mainly involves the ostia and proximal segment of coronary artery, showing the lesions of stenosis, occlusion or dilatation, which result in myocardial ischemia, angina pectoris or AMI [ 4 , 25 ].…”

“…Recently study reported HLA-B*52 allele was significantly associated with TA. However, the ostium involvement of the coronary arteries is caused by the extension of inflammation of the aortic root or ascending aorta [ 14 , 24 , 29 ], which leads to arterial wall remodeling, thickening, aneurysmal lesions, and stenosis or occlusion of the coronary vessel lumen [ 24 , 26 , 29 ]. In the acute inflammatory phase (active stage) of TA proinflammatory T-cell cytokines（such as TNF-α, IL-6 and IFN-γ, etc.)…”

Clinical characteristics and risk factors of coronary artery lesions in Chinese pediatric Takayasu arteritis patients: a retrospective study

“…The coronary artery is an important medium-sized vessel in the heart that may also be involved. Once the lesion is aggravated, thrombosis can develop, leading to MI and even death [21][22][23][24] . Even if immediate ischemia does not occur because of coronary artery occlusion, vessels that have been in amed in systemic vasculitides, such as TAK, show premature atherosclerosis, placing patients at risk for MI [25] .…”