Percutaneous coronary intervention for left main trunk ostial stenosis in a patient with Takayasu's arteritis

Area of Science:

• Cardiology
• Vascular Biology
• Immunology

Background:

• Takayasu's arteritis is a rare inflammatory condition affecting large arteries.
• Coronary artery involvement in Takayasu's arteritis is uncommon, particularly in male patients.
• Left main trunk (LMT) ostial stenosis can lead to severe cardiac events.

Purpose of the Study:

• To report a rare case of Takayasu's arteritis with left main trunk ostial stenosis in a young male.
• To illustrate the utility of virtual histology intravascular ultrasound (VH-IVUS) in managing coronary artery lesions in Takayasu's arteritis.
• To present the successful management of LMT ostial stenosis with bare metal stent implantation.

Main Methods:

• Case presentation of a 25-year-old male diagnosed with Takayasu's arteritis.
• Diagnostic imaging including multidetector computed tomography (MDCT) and coronary angiography.
• Assessment of coronary artery wall structure using virtual histology intravascular ultrasound (VH-IVUS).
• Intervention involving bare metal stent implantation for LMT ostial stenosis.

Main Results:

• The patient presented with effort angina due to severe LMT ostial stenosis.
• VH-IVUS revealed fibrous thickening of the coronary artery wall, characteristic of arteritis.
• Successful bare metal stent implantation was performed.
• No restenosis was observed at 6-month follow-up via MDCT.

Conclusions:

• Takayasu's arteritis can manifest with severe coronary artery ostial stenosis, even in men without prior significant large vessel involvement.
• VH-IVUS provides valuable insights into the vascular wall composition, aiding treatment decisions in Takayasu's arteritis.
• Stent implantation is a viable treatment option for LMT ostial stenosis in Takayasu's arteritis, with favorable short-term outcomes.