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Regression of Left Main Coronary Stenosis During Long-Term Tocilizumab Therapy in Takayasu Arteritis

Yoh Arita1, Nobuyuki Ogasawara1

  • 1Department of a Cardiology, Japan Community Healthcare Organization Osaka Hospital, Osaka, Japan.

JACC. Case Reports
|June 12, 2026
PubMed

Insights

Takayasu arteritis can cause severe coronary artery stenosis. Long-term control of inflammation with tocilizumab and careful steroid tapering led to delayed but significant improvement in coronary stenosis in one patient.

Area of Science:

  • Cardiovascular Medicine
  • Rheumatology
  • Immunology

Background:

  • Takayasu arteritis is a chronic inflammatory condition affecting large arteries, often leading to stenosis.
  • Coronary artery involvement in Takayasu arteritis can result in critical stenosis, posing significant cardiovascular risk.
  • Management strategies aim to control inflammation and prevent ischemic events.

Purpose of the Study:

  • To report a case of Takayasu arteritis with critical left main coronary artery stenosis.
  • To investigate the long-term effects of anti-inflammatory therapy and glucocorticoid tapering on coronary stenosis regression.
  • To highlight the potential for delayed improvement in coronary stenosis with sustained inflammatory control.

Main Methods:

  • A 29-year-old woman with Takayasu arteritis and critical left main coronary artery stenosis was treated with prednisolone, tocilizumab, and coronary artery bypass grafting.
  • Serial computed tomography angiography was performed over 6 years to monitor coronary stenosis.
  • Inflammatory biomarkers, including interleukin-6, were monitored to guide treatment adjustments.

Main Results:

  • Serial imaging demonstrated delayed yet marked regression of coronary stenosis over 6 years.
  • Improvement in stenosis occurred during sustained inflammatory control and careful glucocorticoid tapering.
  • No cardiovascular events or graft occlusion were observed, and graft patency was preserved.

Conclusions:

  • Sustained inflammatory suppression with long-term tocilizumab and gradual glucocorticoid tapering may promote delayed regression of coronary stenosis in Takayasu arteritis.
  • Monitoring inflammatory biomarkers, such as interleukin-6, is crucial for guiding individualized glucocorticoid tapering.
  • This case suggests a potential therapeutic window for managing coronary stenosis in Takayasu arteritis through prolonged inflammation suppression.
Abstract

Keywords:
Takayasu arteritiscoronary artery stenosisinterleukin-6tocilizumab

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