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Revista Española de Cardiología (English Edition) Revista Española de Cardiología (English Edition)
Rev Esp Cardiol. 2017;70:391 - Vol. 70 Num.05 DOI: 10.1016/j.rec.2016.06.013

Illuminating Coronary Artery Involvement in Takayasu Arteritis

Félix Valencia-Serrano a,, Alejandro Sánchez-Espino a, Rosa Lázaro-García a

a Servicio de Cardiología, Hospital Universitario Torrecárdenas, Almería, Spain

Article

A 49-year-old woman with Takayasu arteritis was referred for coronary angiography after having a non-ST elevation acute inferior myocardial infarction. The right transradial approach revealed elevated central blood pressure with normal peripheral blood pressures, near occlusion of the axillary artery (Figure 1), and severe stenosis in the middle portion of the right coronary artery (Figure 1 and Video 1 of the supplementary material). Optical coherence tomography (OCT) was performed in the culprit lesion. At the critical level of the stenosis, there was severe fibrointimal thickening with apparent endothelial integrity and no evidence of thrombus (Figure 2 and Video 2 of the supplementary material). Distal to these findings, a region of heterogeneous, hypointense signal with well-defined margins indicated a focal calcium deposit (Figure 2). Proximal and distal to this observation, there were infiltrated hyperintense areas of asymmetric fibrointimal thickening with an acoustic shadow indicating macrophages (Figure 2). Finally, the patient underwent stent implantation (Video 3 of the supplementary material).

Figure 1.

Figure 2.

Multifactorial cardiac involvement is the major cause of death in Takayasu arteritis. Our understanding of the underlying pathophysiology of the coronary artery involvement is based mainly on autopsies. The spatial resolution and in vivo nature of OCT provide a unique opportunity to study the virtual histology of Takayasu arteritis and broaden our knowledge of this entity. In contrast to an earlier case in which only fibrous scar tissue was observed in a patient with ventricular dysfunction, in our patient, OCT demonstrated a critical stenosis associated with a calcium deposit as the underlying pathophysiology of the acute coronary syndrome, in addition to patchy involvement due to a chronic active inflammatory process in the arterial wall.

SUPPLEMENTARY DATA

Video 1

Video 2

Video 3

Corresponding author: valenciafelix@hotmail.com

1885-5857/© 2017 Sociedad Española de Cardiología. Published by Elsevier España, S.L.U. All rights reserved