Coronary Vasculitis in Takayasu's: A Case Report and Review of the Literature on Optimal Surgical Intervention.

Abstract

Takayasu's arteritis (TAK) is a rare, large-vessel vasculitis that typically involves the aorta and its major branches. Patients may experience coronary involvement, most commonly the left main coronary ostia. Patients with coronary artery occlusion often require emergent revascularization; however, there is debate regarding the optimal timing and type of surgical intervention in the setting of TAK. Herein we describe a 32-year-old female presenting with non-ST elevation myocardial infarction (NSTEMI) who underwent percutaneous intervention (PCI) with drug-eluting stent (DES) placement and was subsequently diagnosed with TAK. A 32-year-old female presented to the emergency department with chest pressure and dyspnea. Her electrocardiogram findings and troponin elevation were consistent with NSTEMI and she underwent coronary angiography with DES placement. During angiography, aortic insufficiency was noted. Transesophageal echocardiogram confirmed intimal thickening of the aortic root with aortic regurgitation. She was diagnosed with TAK, started on high-dose steroids, and transferred to a tertiary care center for rheumatology consultation. This patient's clinical course raised several questions regarding surgical intervention in TAK. The optimal timing of surgery and preferred approach (endovascular intervention vs coronary artery bypass grafting [CABG]) were specifically critiqued. While endovascular intervention (PCI with angioplasty or stent) is typically less invasive than CABG, it may be associated with a higher risk of postsurgical re-stenosis and studies are conflicting regarding the optimal approach. Further research is necessary to determine the long-term efficacy and safety of these interventions, as well as their timing in the overall management plan.