Regressed coronary ostial stenosis in a young female with Takayasu arteritis: a case report

Abstract

Background Takayasu arteritis is a rare systemic vasculitis, which affects the aorta and its major branches, especially in young females. Diagnosis and treatment for Takayasu arteritis with coronary stenosis are important to prevent fatal complications. Immunosuppressive treatment such as corticosteroid is a common treatment for this condition. However, the effects of immunosuppressive treatment on inflammatory coronary stenosis caused by Takayasu arteritis remains unknown. Case presentation An 18-year-old female had chest oppression on effort and was referred to our hospital due to ST-segment depression in I, aV L , and V 2–4 on electrocardiogram. Coronary angiography showed severe stenosis in the ostium of both the left main trunk and the right coronary artery. 18 F-fluorodeoxyglucose (FDG) positron emission tomography/computed tomography showed isolated inflammation of the aortic root. She was diagnosed with Takayasu arteritis and treated with combined immunosuppressive treatment with corticosteroid and tocilizumab, which decreased the FDG uptake in the aortic root. Four months after initiation of the immunosuppressive treatment, coronary angiography showed regression of the coronary ostial stenosis. Coronary artery bypass surgery was considered, but the patient rejected invasive revascularization for coronary artery disease. She did not have chest oppression or ST-segment depression after the immunosuppressive treatment. She had no cardiac events for 6 months after discharge. Conclusions We described regressed coronary ostial stenosis in a young female patient with Takayasu arteritis. Immunosuppressive treatment might have a favorable effect on coronary ostial stenosis in Takayasu arteritis.

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

“…Extremely thickened adventitia with fibrosis involving the myocardium and the epicardial nerve plexus was also observed (b) second intervention revealed an accumulation of inflammatory cells with granulomas in a small section. A previous study reported the usefulness of 18F-fluorodeoxyglucosepositron emission tomography for diagnosing coronary Takayasu arteritis [12], which possibly could have helped diagnosis before coronary bypass surgery in the present case.…”

Acute Coronary Syndrome Developed in a 17-year-old Boy with Sitosterolemia Comorbid with Takayasu Arteritis: A Rare Case Report and Review of the Literature

“…In our case, TA was well controlled by the combination of prednisolone and TCZ, and coronary artery stenosis showed slight regression after the administration of these drugs. In an 18-year-old woman with TA who had severe stenosis in the ostium of both the left main trunk and the LAD, 4 months of combined immunosuppressive treatment with corticosteroid and TCZ resulted in a regression of the coronary ostial stenosis (35). Pan et al demonstrated that six-month treatment with tocilizumab improved the degree of lumen stenosis in most lesions of the coronary arteries in patients with TA (36).…”

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

“…Mohan et al reported reduced stenotic lesions of the coronary ostia by steroid treatment in an 11-year-old boy with the aid of cardiac-gated computed tomography [ 18 ]. Tetsuro et al reported attenuated coronary ostial stenosis via coronary angiography with immunosuppressive combination therapies [ 19 ]. As described in our case, an increased EEM area of the ostium of the LMCA was observed by longitudinal evaluation of IVUS at different time points after PTCA and immunosuppressive therapy.…”