Korean Circ J.  2009 Dec;39(12):551-555. 10.4070/kcj.2009.39.12.551.

Takayasu's Arteritis Involving the Ostia of Three Large Coronary Arteries

• Park JS
• Lee HC
• Lee SK
• Kim SP
• Kim YD
• Ahn MS
• Hong TJ

• KMID: 2225645
• DOI: http://doi.org/10.4070/kcj.2009.39.12.551

Abstract

Takayasu's arteritis can involve the ostia of coronary arteries. We report a patient with Takayasu's arteritis involving the ostia of three large coronary arteries who was successfully treated by percutaneous coronary intervention (PCI) with a drug-eluting stent (DES) and had a good clinical outcome after 12 months. A 37-year-old male with unstable angina was admitted to our cardiovascular center. The patient had Takayasu's arteritis and an aortic valve replacement with a metallic valve due to severe aortic regurgitation 7 years previously. Coronary angiography (CAG) showed a 95% discrete eccentric luminal narrowing at the ostia of the large left anterior descending (LAD) and left circumflex (LCX) arteries, and a 99% discrete eccentric luminal narrowing at the ostium of the large right coronary artery (RCA). The patient was treated with prednisolone for 14 days. Two large paclitaxel-eluting stents (PES) were then implanted in the distal left main coronary artery using the kissing stent technique. After 6 months, a CAG did not reveal restenosis or recurrent coronary artery disease. Thus, PCI with a DES for patients with significant coronary involvement secondary to Takayasu's arteritis is an effective and an alternative treatment when coronary bypass grafting is not option.

Keyword

Takayasu arteritis; Stents; Angioplasty; Unstable angina

MeSH Terms

Adult
Angina, Unstable
Angioplasty
Aortic Valve
Aortic Valve Insufficiency
Arteries
Coronary Angiography
Coronary Artery Disease
Coronary Vessels
Drug-Eluting Stents
Humans
Male
Percutaneous Coronary Intervention
Phenobarbital
Prednisolone
Stents
Takayasu Arteritis
Transplants
Phenobarbital
Prednisolone

Figure

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  Fig. 1 Initial coronary angiography. A: selective left coronary angiography shows 95% discrete eccentric luminal narrowing at the ostium of the large LAD and large LCX. B: selective right coronary angiography shows 99% discrete eccentric luminal narrowing at the ostium of the large RCA. LAD: left anterior descending, LCX: left circumflex, RCA: right coronary artery.

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  Fig. 2 Angiography of systemic vessels. A and B: right and left subclavian arteries reveal total occlusion. C: ostium of the right renal artery shows 80% luminal narrowing. D: right superficial femoral artery shows total occlusion with collateral flow.

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  Fig. 3 Coronary angiography (A-D) and IVUS (E and F) during PCI. A and B: a large 5.0×12 mm paclitaxel-eluting stent is implanted in the ostium of the RCA. C and D: two large paclitaxel-eluting stents are implanted from the distal left main coronary artery to the LAD and LCX by the kissing stent technique (LAD: 5.0 mm×24 mm at 14 atm, LCX; 5.0×16 mm at 14 atm). E and F: IVUS show good apposition of kissing stents minimally overlapped from the distal left main coronary artery to the LAD and LCX. RCA: right coronary artery, LAD: left anterior descending, LCX: left circumflex, IVUS: Intravascular ultrasound, PCI: percutaneous coronary intervention.

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  Fig. 4 Follow up coronary angiography (A and B) and IVUS (C and D). A and B: coronary angiography does not show restenosis or recurrence of coronary artery disease in LAD, LCX, and RCA. C and D: IVUS shows little neointimal proliferation and stent malapposition in the distal part of the LAD stent. LAD: left anterior descending, LCX: left circumflex, RCA: right coronary artery, IVUS: Intravascular ultrasound.

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