Department of Cardiovascular Medicine, Fukushima Medical University, 1 Hikarigaoka Fukushima, Fukushima, 960-1247, Japan.
Department of Cardiology, Hoshi General Hospital, Koriyama, Japan.
BMC Cardiovasc Disord. 2020 Jun 1;20(1):260. doi: 10.1186/s12872-020-01541-x.
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.
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.
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.
孤立性冠状动脉 Takayasu 动脉炎是一种罕见的缺血性心脏病形式，通常表现为主动脉-动脉口病变。尽管包括超声、计算机断层血管造影、磁共振血管造影或导管血管造影在内的几种血管成像方式在诊断 Takayasu 动脉炎方面发挥着关键作用，但 Takayasu 动脉炎的血管内超声成像尚未得到充分研究。
一名 55 岁女性，诊断为杂合家族性高胆固醇血症，因劳力性心绞痛行冠状动脉造影，显示左前降支（LAD）开口狭窄。尽管成功进行了定向冠状动脉旋磨术加药物涂层球囊治疗，但 6 个月后 LAD 开口处出现再狭窄，左回旋支（LCx）开口明显进展。这些病变的血管内超声成像引人注目，其中中膜部分不可辨认，回声强度类似于纤维性内膜增厚，从内膜延伸到外膜，导致整个冠状动脉图像变得不清晰。再次对 LAD 和 LCx 病变进行定向冠状动脉旋磨术加药物涂层球囊治疗。计算机断层血管造影的系统检查除了冠状动脉狭窄外，没有发现其他狭窄病变。5 个月后，LAD 和 LCx 病变弥漫性进展，因此进行了冠状动脉旁路移植术。旁路移植术中获得的冠状动脉标本的组织病理学检查显示内膜和外膜过度纤维性增厚，中膜有肉芽肿性炎症，导致孤立性冠状动脉 Takayasu 动脉炎的诊断。随后开始全身皮质类固醇治疗。
我们描述了一例极其罕见的孤立性和非主动脉-动脉口 Takayasu 动脉炎病例。病变冠状动脉的特征性血管内超声图像可能有助于冠状动脉 Takayasu 动脉炎的诊断。
