Department of Cardiovascular Medicine, Fukushima Medical University, 1 Hikarigaoka, Fukushima, Fukushima, 960-1295, Japan.
Department of Pulmonary Hypertension, Fukushima Medical University, Fukushima, Japan.
BMC Cardiovasc Disord. 2019 Apr 2;19(1):79. doi: 10.1186/s12872-019-1066-7.
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.
An 18-year-old female had chest oppression on effort and was referred to our hospital due to ST-segment depression in I, aV, and V on electrocardiogram. Coronary angiography showed severe stenosis in the ostium of both the left main trunk and the right coronary artery. 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.
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.
Takayasu 动脉炎是一种罕见的系统性血管炎，主要影响主动脉及其主要分支，尤其在年轻女性中多见。Takayasu 动脉炎合并冠状动脉狭窄的诊断和治疗对于预防致命性并发症非常重要。免疫抑制治疗（如皮质类固醇）是该病的常见治疗方法。然而，免疫抑制治疗对 Takayasu 动脉炎引起的炎症性冠状动脉狭窄的影响尚不清楚。
一名 18 岁女性在用力时出现胸闷，因心电图 I、aV 和 V 导联 ST 段压低而被转至我院。冠状动脉造影显示左主干和右冠状动脉开口严重狭窄。氟-脱氧葡萄糖（FDG）正电子发射断层扫描/计算机断层扫描显示主动脉根部孤立性炎症。她被诊断为 Takayasu 动脉炎，并接受皮质类固醇和托珠单抗联合免疫抑制治疗，该治疗降低了主动脉根部的 FDG 摄取。免疫抑制治疗开始后 4 个月，冠状动脉造影显示冠状动脉开口狭窄消退。考虑行冠状动脉旁路移植术，但患者拒绝行有创性血管重建术治疗冠状动脉疾病。免疫抑制治疗后，患者无胸闷或 ST 段压低。出院后 6 个月内无心脏事件发生。
我们描述了一例年轻女性 Takayasu 动脉炎患者冠状动脉开口狭窄消退。免疫抑制治疗可能对 Takayasu 动脉炎的冠状动脉开口狭窄有良好的效果。
