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以左主干冠状动脉开口负性重构为首发表现的 Takayasu 动脉炎致急性心肌梗死 1 例报告。

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

机构信息

Department of Cardiology, Xi'jing Hospital, Air Force Medical University, Changle West Road, Xi'an, 710032, China.

Department of Cardiology, Radboud University, Nijmegen, The Netherlands.

出版信息

BMC Cardiovasc Disord. 2021 Nov 22;21(1):560. doi: 10.1186/s12872-021-02376-w.

DOI:10.1186/s12872-021-02376-w
PMID:34809570
原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC8607707/
Abstract

BACKGROUND

Takayasu arteritis is a chronic inflammatory disease involving the aorta and its major branches. Acute myocardial infarction rarely but not so much presents in patients with Takayasu arteritis, and the preferable revascularization strategy is still under debate.

CASE PRESENTATION

A 22-year-old female with Takayasu arteritis presented with acute myocardial infarction. Coronary angiography and intravenous ultrasound (IVUS) showed that the right coronary artery (RCA) was occluded and that there was severe negative remodelling at the ostium of the left main coronary artery (LMCA). The patient was treated by primary percutaneous transluminal coronary angioplasty (PTCA) with a scoring balloon in the LMCA, without stent implantation. After 3 months of immunosuppressive medication, the patient received RCA revascularization by stenting. There was progressive external elastic membrane (EEM) enlargement of the LMCA ostium demonstrated by IVUS at 3 and 15 months post-initial PTCA.

CONCLUSION

Here, we report a case of Takayasu arteritis with involvement of the coronary artery ostium. Through PTCA and long-term immunosuppressive medication, we found that coronary negative remodelling might be reversible in patients with Takayasu arteritis.

摘要

背景

Takayasu 动脉炎是一种累及主动脉及其主要分支的慢性炎症性疾病。Takayasu 动脉炎患者很少发生急性心肌梗死，但也并非罕见，其首选血运重建策略仍存在争议。

病例介绍

一名 22 岁女性患有 Takayasu 动脉炎，突发急性心肌梗死。冠状动脉造影和静脉内超声（IVUS）显示右冠状动脉（RCA）闭塞，左主干冠状动脉（LMCA）开口处存在严重的负性重构。患者在 LMCA 行经皮腔内冠状动脉成形术（PTCA），采用球囊扩张，未植入支架。免疫抑制治疗 3 个月后，患者接受了 RCA 支架置入术血运重建。初次 PTCA 后 3 个月和 15 个月时的 IVUS 显示，LMCA 开口处的外弹力膜（EEM）逐渐增大。

结论

本研究报告了一例累及冠状动脉开口的 Takayasu 动脉炎病例。通过 PTCA 和长期免疫抑制治疗，我们发现 Takayasu 动脉炎患者的冠状动脉负性重构可能是可逆的。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/4964/8607707/1fcfd346842a/12872_2021_2376_Fig6_HTML.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/4964/8607707/416157d9d003/12872_2021_2376_Fig1_HTML.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/4964/8607707/6b81706afdf9/12872_2021_2376_Fig2_HTML.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/4964/8607707/f1d38b383600/12872_2021_2376_Fig3_HTML.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/4964/8607707/b18192575759/12872_2021_2376_Fig4_HTML.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/4964/8607707/198b0f114677/12872_2021_2376_Fig5_HTML.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/4964/8607707/1fcfd346842a/12872_2021_2376_Fig6_HTML.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/4964/8607707/416157d9d003/12872_2021_2376_Fig1_HTML.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/4964/8607707/6b81706afdf9/12872_2021_2376_Fig2_HTML.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/4964/8607707/f1d38b383600/12872_2021_2376_Fig3_HTML.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/4964/8607707/b18192575759/12872_2021_2376_Fig4_HTML.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/4964/8607707/198b0f114677/12872_2021_2376_Fig5_HTML.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/4964/8607707/1fcfd346842a/12872_2021_2376_Fig6_HTML.jpg

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