Intravascular ultrasound imaging of isolated and non aorto-ostial coronary Takayasu arteritis: a case report

Abstract

Background: Isolated coronary Takayasu arteritis is a rare form of ischemic heart disease that typically appears as an aorto-ostial lesion. Although several vascular imaging modalities including ultrasonography, computed tomographic angiography, magnetic resonance angiography or catheter angiography, play crucial roles for diagnosing Takayasu arteritis, the intravascular ultrasound imaging of Takayasu arteritis is not well studied. Case presentation: A 55-year-old woman who was diagnosed with heterozygous familial hypercholesterolemia underwent coronary angiography due to effort angina, which showed ostial left anterior descending coronary artery (LAD) stenosis. Although directional coronary atherectomy followed by drug-coated balloon was successfully performed, 6 months later restenosis occurred at the ostial LAD, and the ostial left circumflex coronary artery (LCx) progressed significantly. The intravascular ultrasound imaging in these lesions was noteworthy, in which the media was partly unrecognizable and an echo intensity similar to fibrotic intimal thickening traversed from the intima to the adventitia, thereby causing the whole image of the coronary artery to become unclear. Directional coronary atherectomy followed by drug-coated balloon procedures for both LAD and LCx lesions were performed again. Systemic examination of computed tomographic angiography found no other stenotic lesions except for those in the coronary arteries. Five months later, the LAD and LCx lesions progressed diffusely, therefore the coronary artery bypass graft was done. The histopathological findings of specimens of the coronary artery that were obtained during the bypass graft showed excessive fibrous thickening of the intima and adventitia, with granulomatous inflammation in the media, which led to the diagnosis of isolated coronary Takayasu arteritis. Systemic corticosteroid therapy was then started. Conclusions: We described an extremely rare case of isolated and non aorto-ostial Takayasu arteritis. The characteristic intravascular ultrasound images of diseased coronary arteries may help in the diagnosis of coronary Takayasu arteritis.

Isolated Coronary Arteritis Treated With FDG-PET/CT-Guided Immunosuppressant to Break the Vicious Cycle of In-Stent Restenosis

“…However, in the present case, IVUS findings were similar to those of coronary involvement in Takayasu's arteritis, so tocilizumab was used. 5 , 6 This case highlighted that the immunosuppressive drugs such as are effective, and follow-up FDG-PET/CT is useful in monitoring response to immunosuppressive drugs in patients with coronary arteritis even of unknown cause.…”

Coronary artery lesions in Takayasu arteritis

“…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. Notably, the media was partly unrecognizable, and an echo intensity similar to fibrotic intimal thickening traversed from the intima to the adventitia, making the whole image of the coronary artery unclear [ 43 ].…”

“…Soto et al [ 36 ] observed typical AP in 62.5% of patients with CAL, atypical AP in 12.5%, and dyspnea in 25%. Shimizu et al [ 43 ] described TAK with isolated CAL in a 55-year-old woman with heterozygous familial hypercholesterolemia who complained of exertional AP.…”

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

“…However, there are only individual case reports concerning the application of IVUS in patients with Takayasu arteritis. Takeshi et al reported unrecognized media and the expansion of fibrotic thickening from the media to the adventitia in Takayasu arteritis patients [ 8 ]. Klaus et al reported several hypoechogenicities in the wall of coronary artery [ 9 ].…”