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Case Reports
. 2019 Apr 2;19(1):79.
doi: 10.1186/s12872-019-1066-7.

Regressed coronary ostial stenosis in a young female with Takayasu arteritis: a case report

Tetsuro Yokokawa  1   2 , Hiroyuki Kunii  3 , Takashi Kaneshiro  3 , Shohei Ichimura  3 , Akiomi Yoshihisa  3   4 , Makiko Yashiro Furuya  5 , Tomoyuki Asano  5 , Kazuhiko Nakazato  3 , Takafumi Ishida  3 , Kiyoshi Migita  5 , Yasuchika Takeishi  3
Affiliations
Case Reports

Regressed coronary ostial stenosis in a young female with Takayasu arteritis: a case report

Tetsuro Yokokawa et al. BMC Cardiovasc Disord. .

Abstract

Background: 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.

Case presentation: An 18-year-old female had chest oppression on effort and was referred to our hospital due to ST-segment depression in I, aVL, and V2-4 on electrocardiogram. Coronary angiography showed severe stenosis in the ostium of both the left main trunk and the right coronary artery. 18F-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.

Conclusions: 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.

Keywords: 18F-fluorodeoxyglucose positron emission tomography/computed tomography; Case report; Coronary ostial stenosis; Regression; Takayasu arteritis; Tocilizumab.

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Conflict of interest statement

Ethics approval and consent to participate

This study was approved by the ethics committee of Fukushima Medical University and written informed consent was provided by the patient.

Consent for publication

Consent for publication was obtained by the patient in written form.

Competing interests

Tetsuro Yokokawa belongs to a department supported by Actelion Pharmaceuticals Japan Ltd. Akiomi Yoshihisa belongs to a department supported by Fukuda Denshi Co, Ltd. These companies are not associated with the contents of this study. No other authors have competing interests associated with this study.

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Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Figures

Fig. 1
Fig. 1
Electrocardiogram. a. Electrocardiogram showed ST-segment depression in leads I, aVL, and V2–4. b. Electrocardiogram showed no ST-segment depression after the treatment
Fig. 2
Fig. 2
Coronary angiography. a, b. Initial coronary angiography showed severe stenosis in the ostium of both the left main trunk and the right coronary artery. c, d. Four months after immunosuppressive treatment, coronary angiography showed significant regression of the right coronary ostial stenosis, but limited regression of the left coronary ostial stenosis
Fig. 3
Fig. 3
Contrast-enhanced computed tomography. a, b. No significant aortic lesion was detected by contrast-enhanced computed tomography
Fig. 4
Fig. 4
18F-fluorodeoxyglucose (FDG) positron emission tomography (PET)/computed tomography (CT). a, b. 18F-FDG PET/CT showed isolated inflammation of the aortic root on admission. The maximum standardized uptake value (max SUV) was 6.3. c, d. After immunosuppressive treatment, 18F-FDG PET/CT showed decreased 8F-FDG uptake in the aortic root. The max SUV was decreased to 4.3
Fig 5
Fig 5
Clinical course. CAG, coronary angiography; CT, computed tomography; CRP, C-reactive protein; ESR, erythrocyte sedimentation rate; FDG, fluorodeoxyglucose; PET, positron emission tomography; PSL, prednisolone, SAA, serum amyloid A; mPSL, methylprednisolone
Fig. 6
Fig. 6
Myocardial perfusion imaging with 13N-ammonia positron emission tomography. Stress and rest 13N-ammonia perfusion imaging demonstrated significantly decreased uptake in the anterior and lateral lesions and slightly decreased uptake in the inferior lesion. CTAC, computed tomography-based attenuation correction; HLA, horizontal long axis; SA, short axis; VLA, vertical long axis
See this image and copyright information in PMC

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