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[Coronary revascularization provides confirmation of coronary and aortic giant-cell vasculitis]
C Le Hello1, D Maïza, F Galateau-Sallé
1Département de Chirurgie Cardiovasculaire, Centre Hospitalier Universitaire, Caen.
Insights
Unstable angina in a patient with a history of temporal arteritis was linked to vasculitis. Prompt diagnosis and treatment, including bypass surgery, led to a positive long-term outcome, highlighting the importance of considering giant-cell arteritis in cardiovascular cases.
Area of Science:
- Cardiology
- Rheumatology
- Pathology
Background:
- Temporal arteritis (giant-cell arteritis) is an inflammatory condition primarily affecting large arteries.
- Cardiovascular manifestations can occur, but coronary artery involvement is less common.
- Corticosteroid therapy is the mainstay for treating giant-cell arteritis.
Observation:
- A 58-year-old woman presented with unstable angina pectoris 28 months post-corticosteroid treatment for biopsy-proven temporal arteritis.
- Coronary angiography revealed critical left main coronary artery stenosis.
- Initial corticosteroid treatment yielded no improvement.
Findings:
- Histological examination of the coronary artery confirmed vasculitis.
- An aortocoronary bypass was successfully performed.
- Continued corticosteroid therapy was administered.
Implications:
- This case underscores that cardiovascular events in patients with a history of temporal arteritis may represent a recurrence or new manifestation of giant-cell arteritis.
- Early recognition and comprehensive management, including surgical intervention when necessary, are crucial for favorable outcomes.
- Vigilance for systemic vasculitis is warranted in patients with temporal arteritis presenting with cardiac symptoms.
Abstract:
The present report describes a 58-year-old woman who had unstable angina pectoris 28 months after the end of corticosteroid treatment prescribed for biopsy-proven temporal arteritis. Coronary angiogram disclosed critical left main coronary artery stenosis. Despite a 3-week corticosteroid regimen no improvement was obtained and an aortocoronary bypass was performed. Histological examination of the affected artery showed vasculitis. Corticosteroid treatment was continued. Six months later, symptoms had not recurred and the coronary bypass graft was permeable. The stress test was negative fifteen months after surgery and the patient remained clinically well thirty months later. For any patient with current or previous temporal arteritis, any cardiovascular manifestation might be a new episode of giant-cell arteritis.