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Retrograde Percutaneous Coronary Intervention in a Case of Takayasu Arteritis with Left Main Coronary Artery Chronic

Prathap Kumar1, Blessvin Jino1, Stalin Roy1

  • 1Department of Cardiology, Meditrina Hospital, Kollam, Kerala, India.

Case Reports in Cardiology
|March 22, 2022
PubMed

Insights

Takayasu arteritis patients with coronary artery bypass graft failure can benefit from percutaneous coronary intervention. Drug-coated balloons are effective for repeat revascularization after stent failure in Takayasu arteritis.

Area of Science:

  • Cardiology
  • Interventional Cardiology
  • Vascular Medicine

Background:

  • Takayasu arteritis (TA) commonly affects coronary arteries, leading to restenosis post-percutaneous coronary intervention (PCI).
  • Coronary artery bypass graft (CABG) surgery failure in TA patients can still be managed with PCI.
  • Drug-coated balloons (DCBs) offer a solution for repeat revascularization in cases of stent failure within TA.

Observation:

  • A 31-year-old female with a history of TA and CABG presented with exertional angina.
  • Coronary angiography revealed left main coronary artery (LMCA) ostial occlusion and a non-patent left internal mammary artery (LIMA) graft.
  • Initial attempts at antegrade PCI were unsuccessful, necessitating a retrograde approach followed by an antegrade repeat attempt.

Findings:

  • Intravascular ultrasound (IVUS)-guided stenting of the LMCA-LAD was performed.
  • The patient developed in-stent restenosis three months post-procedure, confirmed by optical coherence tomography (OCT) showing neointimal hyperplasia.
  • OCT-guided PCI using a sirolimus-coated balloon successfully treated the restenosis.

Implications:

  • This case highlights the successful use of a combined retrograde and antegrade approach for complex LMCA interventions in TA.
  • Drug-coated balloons are crucial for managing restenosis after PCI in TA patients.
  • The findings suggest that PCI, including repeat interventions with DCBs, remains a viable strategy for coronary disease in TA, even after CABG failure.
Abstract

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