Department of Internal Medicine, MedStar Georgetown University Hospital, Washington DC, 20007, USA.
Division of Cardiovascular Sciences, , USF Morsani College of Medicine, 2 Tampa General, Circle, STC 5Th Floor, Tampa, Fl, 33606, USA.
BMC Cardiovasc Disord. 2024 Apr 2;24(1):190. doi: 10.1186/s12872-024-03841-y.
Polyarteritis Nodosa (PAN) is a systemic vasculitis (SV) historically thought to spare the coronary arteries. Coronary angiography and contemporary imaging reveal coronary stenosis and dilation, which are associated with significant morbidity and mortality. Coronary arteries in PAN are burdened with accelerated atherosclerosis from generalized inflammation adding to an inherent arteritic process. Traditional atherosclerotic risk factors fail to approximate risk. Few reports document coronary pathology and optimal therapy has been guarded.
Database publication query of English literature from 1990-2022.
Severity of coronary involvement eludes laboratory monitoring, but coronary disease associates with several clinical symptoms. Framingham risk factors inadequately approximate disease burden. Separating atherosclerosis from arteritis requires advanced angiographic methods. Therapy includes anticoagulation, immunosuppression and revascularization. PCI has been the mainstay, though stenting is confounded by vagarious alteration in luminal diameter and reports of neointimization soon after placement.
When graft selection avoids the vascular territory of SV's, CABG offers definitive therapy. We have contributed report of a novel CABG configuration in addition to reviewing, updating and discussing the literature. Accumulating evidence suggests discrete clinical symptoms warrant suspicion for coronary involvement.
结节性多动脉炎（PAN）是一种系统性血管炎（SV），历史上被认为不会累及冠状动脉。冠状动脉造影和现代影像学显示冠状动脉狭窄和扩张，这与显著的发病率和死亡率相关。PAN 中的冠状动脉受到全身炎症引起的加速动脉粥样硬化的影响，这增加了固有动脉炎过程的风险。传统的动脉粥样硬化危险因素无法准确估计风险。很少有报道描述冠状动脉的病理变化，最佳治疗方法也受到限制。
对 1990 年至 2022 年英语文献的数据库出版物进行查询。
冠状动脉受累的严重程度难以通过实验室监测来评估，但冠状动脉疾病与几种临床症状相关。弗雷明汉危险因素不能充分估计疾病负担。要将动脉粥样硬化与动脉炎分开，需要先进的血管造影方法。治疗包括抗凝、免疫抑制和血运重建。经皮冠状动脉介入治疗（PCI）一直是主要的治疗方法，尽管支架置入后由于管腔直径的不规则变化和新生内膜形成的报告，支架的应用受到限制。
当移植物选择避开 SV 的血管区域时，冠状动脉旁路移植术（CABG）提供了明确的治疗方法。除了回顾、更新和讨论文献外，我们还报告了一种新型的 CABG 构型。越来越多的证据表明，特定的临床症状提示存在冠状动脉受累。
