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Progressive coronary aneurysms in Behçet disease, a journey through surgical and percutaneous treatment: A case
Aysha Husain1, Abdalkareem Al-Allaf1, Maha AlAmri1
1Heart Center, King Faisal Hospital and Research Center, Riyadh, Saudi Arabia.
Insights
Behçet disease, a rare autoimmune condition, can cause aggressive coronary aneurysms presenting as acute coronary syndrome. Interventions like bypass surgery and stenting may be necessary despite medical therapy.
Area of Science:
- Cardiology
- Rheumatology
- Vascular Medicine
Background:
- Behçet disease is a systemic autoimmune disorder characterized by vascular inflammation.
- Coronary artery involvement, including stenosis, arteritis, and aneurysm formation, is uncommon but can be severe.
- Standard treatment focuses on systemic immunosuppression with steroids and other medications.
Purpose of the Study:
- To present a case of Behçet disease presenting with aggressive coronary aneurysms and acute coronary syndrome.
- To highlight the challenges in managing Behçet disease-related coronary artery pathology.
- To discuss the role of interventional and surgical approaches in critical cases.
Main Methods:
- Case report of a 34-year-old male with acute coronary insult.
- Review of diagnostic findings and clinical course.
- Description of interventions including bypass graft surgery and percutaneous coronary intervention with cover stents.
Main Results:
- The patient presented with acute coronary syndrome attributed to Behçet disease.
- He required emergency bypass graft surgery for a ruptured coronary aneurysm and cardiac tamponade.
- Despite medical management, he later developed multiple coronary aneurysms necessitating percutaneous intervention with cover stents.
Conclusions:
- Behçet disease is a rare but significant cause of coronary aneurysms presenting with acute coronary syndrome.
- Coronary aneurysms in Behçet disease carry a high risk of rupture, requiring aggressive management.
- Surgical and interventional procedures, such as bypass grafting and cover stents, may be crucial adjuncts to medical therapy with variable outcomes.
Abstract:
Behçet disease is a systemic autoimmune disease that causes inflammation within the vascular tree. Coronary arteries are rarely involved with stenosis, arteritis or aneurysm formation. Treatment is mainly directed to reduce the burden of inflammation systemically with steroid and immunosuppressive medications. However, patients might present in critical conditions requiring interventions in the form of percutaneous therapy or surgical bypass grafting. We present the case of a 34-year-old male who presented with acute coronary insult and was later found to have Behçet disease. His course was aggressive, as he required bypass graft surgery for rupture coronary aneurysm and cardiac tamponade. Later on, he required percutaneous intervention with cover stents for multiple coronary aneurysms that he developed afterward despite being on medical therapy. <Learning objective: Behçet disease is a rare cause of coronary aneurysms that present with acute coronary syndrome. The underlying etiology is related to inflammatory changes within the vessels. The main stay of treatment is medical therapy that suppresses the immune system. As these aneurysms are at risk of rupture, percutaneous interventions in the form of cover stents and bypass graft surgeries have been used with variable outcomes.>.
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