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

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.

Keywords: Case report; Coronary artery; Intravenous ultrasound; Negative remodelling; Takayasu arteritis.

Fig. 1

Electrocardiogram. The preoperative electrocardiogram showed ST-segment elevation in the aVR lead and ST-segment depression in the other leads

Fig. 2

Coronary angiography. a Severe stenosis at the ostium of the left main coronary artery (LMCA). b The right coronary artery (RCA) was totally occluded, and the distal part of the vessel was visualized via collaterals. c The LMCA after angioplasty

Fig. 3

Intravenous ultrasound (IVUS) images. After the first percutaneous transluminal coronary angioplasty (PTCA), IVUS demonstrated that the external elastic membrane (EEM) areas of the ostium, proximal segment and middle segment of the LMCA were 7.11 (a), 8.34 (b) and 15.68 (c), respectively (in mm²). It also showed negative remodelling of the ostium of the LMCA (remodelling index = 0.45). The remodelling index was calculated by the ratio of the EEM areas of the middle LMCA segment to the LMCA ostium (7.11 mm²/15.68 mm²)

Fig. 4

Electrocardiogram. The postoperative electrocardiogram showed no ST-segment depression

Fig. 5

IVUS image. The result of follow-up IVUS examination at 3 months post-initial PTCA showed that the EEM area of the LMCA ostium was 11.74 (in mm²)

Fig. 6

Coronary angiography and IVUS image. At 15 months follow-up after the first percutaneous coronary intervention, coronary angiography revealed regression of the LMCA ostium (a) and good patency of the RCA stent site (b), and IVUS showed that the EEM area at the ostium of LMCA was 12.85 (c) (in mm²)