Stentless left main revascularisation for takayasu arteritis using directional coronary atherectomy and a drug-coated...

Coronary involvement in Takayasu arteritis is characterized by chronic fibrotic thickening of the arterial intima and is associated with a high risk of restenosis after coronary intervention. In young women, coronary artery bypass grafting and coronary stenting are often undesirable, owing to long-term procedural implications and considerations regarding future pregnancy.

A 21-year-old woman presented with severe left main coronary artery stenosis caused by Takayasu arteritis. After inflammation had been adequately controlled with glucocorticoid therapy and a monoclonal antibody directed against the interleukin-6 receptor, stentless revascularization was undertaken. Directional removal of fibrotic tissue was followed by inflation of a drug-coated coronary balloon. This approach led to a complete relief of the patient's symptoms, and imaging over 5 years demonstrated sustained patency of the left main coronary artery without restenosis. The patient gave birth to two healthy children without experiencing cardiovascular complications.

This case illustrates the potential value of a stentless strategy that integrates systemic control of vascular inflammation with targeted removal of fibrotic coronary tissue. The favourable long-term outcome emphasizes the importance of deferring coronary intervention until inflammatory activity has been adequately suppressed. It further suggests that a personalized revascularization approach without stent implantation may be a viable alternative in patients for whom conventional bypass surgery or coronary stenting is undesirable.