Rapid progression of coronary artery disease in a patient with retroperitoneal fibrosis

Area of Science:

• Cardiology
• Vascular Medicine
• Inflammatory Diseases

Background:

• A 76-year-old woman with hypertension and dyslipidemia presented with acute anterior myocardial infarction.
• Initial coronary angiography revealed left anterior descending (LAD) and left circumflex (LCX) artery occlusions, treated with a paclitaxel-eluting stent in the LAD.

Observation:

• Two weeks post-stenting, the patient developed abdominal pain, with CT and FDG-PET/CT scans indicating perivascular cuffing and increased uptake around the abdominal aorta, suggestive of retroperitoneal fibrosis.
• Serial coronary angiographies demonstrated rapid progression of coronary artery lesions, including new occlusions and stenosis, particularly in the LCX artery and its branches, as well as the posterior descending artery.

Findings:

• The patient was diagnosed with suspected coronary arteritis and initiated on oral corticosteroid therapy.
• Following corticosteroid treatment, a repeat coronary angiography performed five months later showed no further progression of coronary lesions.

Implications:

• This case highlights a potential association between coronary arteritis, retroperitoneal fibrosis, and stent placement.
• Corticosteroid therapy may be effective in managing rapidly progressing coronary artery lesions in the context of suspected arteritis.
• Further research is warranted to elucidate the underlying mechanisms and optimal management strategies for such complex vascular inflammatory conditions.