Objective
Takayashu arteritis is a chronic granulomatous large vessel vasculitis that affects the aorta and its main branches leading to a thickening of the arterial wall and may result in a stenosis, occlusion, dilation, or aneurysm formation. Coronary artery involvement is not rare and its management is still challenging because of the associated lesions and the unsatisfactory results of both surgical and percutaneous procedures. We report two cases emphasizing the difficulties of choosing the optimal management strategy after a literature review in this concern.
Methods
The first case is a 54-year-old female with a recently established diagnosis of Takayashu arteritis who presented with bi-ostial coronary lesions and diffuse systemic lesions (renal, subclavian and iliac arteries stenoses). She underwent a coronary artery bypass grafting surgery with an early dysfunction of the arterial grafts. Then, she was treated using percutaneous coronary, renal, and iliac interventions with good results initially and at one-year follow-up. The second case is a 74-year-old diabetic female with a diagnosis of Takayashu arteritis established at the age of 27 years. She presented to the emergency room for acute pulmonary edema. Investigations revealed multivessel coronary artery disease with renal, subclavian, and iliac artery stenoses. Although coronary artery lesions cannot be imputed to Takayasu arteritis, its management is still questioned by associated lesions and their consequences. She has been treated by coronary and renal stenting, complicated by intrastents restenosis necessitating repeated procedures.
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