The management of complex coronary lesions in a patient with Takayasu arteritis

Contact address: Liviu Macovei, MD, PhD, “Prof. Dr. George I. M. Georgescu”Cardiovascular Diseases Institute, 50 Carol I Avenue, Iasi, Romania. E-mail: [email protected] INTRODUCTION Takayasu arteritis is a rare chronic infl ammatory arteritis of large and medium-sized arteries, a panarteritis with intimal proliferation. This granulomatous panarteritis predominates in women, typically before the age of 40s, with an up to 10:1 ratio for female-to-male1. The aorta may be involved throughout its entire length and, even though any of its branches can be diseased, the most commonly affected are the subclavian and the common carotid arteries. The pulmonary arteries are involved for up to 50% of patients, much less being described the critical coronary lesions and the major aortic regurgitation2,3. Coronary disease is often asymptomatic, as illustrated by the identifi cation of silent myocardial injury for 27% of patients. Myocardial perfusion defects were present in 53% of the cases, while intra-arterial angiography has shown that the coronary artery lesions typically affected the ostia and proximal segments for up to 30% of the cases4,5. There are important limitations in Takayasu arteritis, sometimes the endovascular or surgery treatment involving a higher risk, due to diffuse calcifi cations. The care of patients with TA requires a team approach that includes clinicians familiar with the proper use of immunosuppressive therapies, vascular imaging and inter vention specialists and, in the setting of critical stenosis or aneurysms, cardiovascular surgeons. For most patients, medical and surgical therapies provide important palliation6,7.