Isolated left coronary ostial stenosis as the sole arterial involvement in Takayasu's disease

Abstract

A 24-year-old woman with Takayasu's disease developed unstable angina pectoris. Angiographic studies demonstrated an isolated left coronary ostial stenosis without any other systemic arterial involvement. She is unique in that the coronary lesion, which is rarely the major manifestation of Takayasu's disease, is the sole arterial involvement of the disease.

Coronary Artery Involvement in Takayasu Arteritis in 45 Chinese Patients

“…Isolated coronary involvement is very rare, probably appearing in fewer than 5% of cases 11,12,13 , which may make clinical diagnosis difficult. Isolated coronary involvement is very rare, probably appearing in fewer than 5% of cases 11,12,13 , which may make clinical diagnosis difficult.…”

2010 ACCF/AHA/AATS/ACR/ASA/SCA/SCAI/SIR/STS/SVM Guidelines for the Diagnosis and Management of Patients With Thoracic Aortic Disease

“…While patients with Type A dissection or annuloaortic ectasia may be protected from atherosclerosis (383), patients with Takayasu arteritis may occasionally have inflammatory coronary involvement with coronary aneurysms (less than 10%) (384,385). Similarly, an occasional patient with GCA may have coronary artery involvement (386,387). If ascending aortic surgery is being considered, with or without aortic valve surgery, then identification of the coronary anatomy and any underlying CAD is important for planning the best operation.…”

Case 4-1995

“…Coronary-artery manifestations as the sole clinical evidence of Takayasu's arteritis have been reported only rarely. 38,43 Except for a very low positive titer of antinuclear antibodies, there was no evidence of systemic lupus erythematosus or another autoimmune or inflammatory disease. Although antiphospholipid antibodies have been associated with coronary artery disease, 25,44 this patient's third set of assays for anticardiolipin antibodies was negative, like the first set, and the second set probably yielded a false positive IgG level.…”

“…N ICKELEIT : Data on that occurrence are limited to individual case reports. [36][37][38][39][40] Coronary blood flow in Takayasu's arteritis can be decreased by involvement of the ostia or the proximal segments of the coronary arteries. Involvement of distal coronary segments and aneurysm formation are rare.…”

“…Involvement of distal coronary segments and aneurysm formation are rare. 38,40 Although only a minority of patients affected by Takayasu's arteritis have impaired coronary blood flow, cardiac complications (ischemia, regurgitation, and systemic or pulmonary hypertension) are the major causes of death. Most isolated coronary-artery ostial stenoses, however, even in middle-aged women, are caused by atherosclerosis.…”