Refractory Takayasu’s Arteritis with Severe Coronary Involvement—Case Report and Literature Review

Cobilinschi, Claudia; Grădinaru, Elena; Saulescu, I.; Carstea, Nicolae; Caraiola, Simona; Bălănescu, Andra; Opriş-Belinski, Daniela

doi:10.3390/jcm12134394

Cited by 5 publications

(4 citation statements)

References 43 publications

(71 reference statements)

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“…The treatment of patients with TAK involves two main approaches: the use of medications aimed at suppressing inflammation to reduce vascular damage, remodeling, and interventional procedures that can address the consequences of the disease, such as thrombus formation, tissue hypoperfusion, or ischemia [ 40 ].…”

Section: Discussionmentioning

confidence: 99%

“…The optimal treatment of CAL can significantly improve the prognosis of patients [ 13 ]. The treatment of patients with TAK with CAL remains complex and requires both medical therapy and interventional and surgical myocardial revascularization methods to prevent life-threatening events [ 40 ].…”

Section: Discussionmentioning

confidence: 99%

“…Involvement of the coronary arteries in TAK leads to the development of stable angina pectoris (AP) corresponds to the term: stable coronary artery disease (SCAD), unstable angina pectoris (unstable coronary artery disease -UCAD), myocardial infarction (MI), and sudden death [1,2,19,24,[38][39][40][41][42]. Table II shows the frequency of AP in patients with TAK and CAL.…”

Section: Coronary Artery Lesionsmentioning

confidence: 99%

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Coronary artery lesions in Takayasu arteritis

Dzhus,

Mostbauer

2024

Reumatologia

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IntroductionTakayasu arteritis (TAK) is a granulomatous inflammation of vessels of large diameter, mainly affecting the aorta and its proximal branches, which is more common in young women. The incidence of coronary artery disease in TAK is unknown and not sufficiently studied.Material and MethodsA literature review was performed for the period 2003 to 2023 using a search of the PubMed and Scopus scientific databases. We used the following key words to search the academic journal data-bases: “Takayasu arteritis”, “coronary angiography”, “myocardial revascularization”, “coronary artery disease”, “angina pectoris”, and “myocardial infarction”.ResultsThe analysis of studies showed that coronary artery lesions (CAL) in TAK are not uncommon, being identified particularly in children and young individuals. Pathology of the coronary arteries increases the morbidity and mortality of TAK patients. In TAK, the ostia and proximal segments of the coronary arteries are more frequently affected, presenting as stenosis or occlusion with the development of stable coronary artery disease, unstable coronary artery disease, acute myocardial infarction, and sudden death. The diagnosis of TAK and coronary artery pathology is often complicated due to non-specific manifestations and frequently the absence of symptoms. The treatment of patients with TAK with CAL is challenging and requires both pharmacological therapy and interventional or surgical methods of myocardial revascularization.ConclusionsTakayasu arteritis is a more prevalent cause of CAL development, especially in young patients, than previously believed, and cardiovascular death due to CAL is not rare. Early diagnosis of TAK with CAL, particularly occlusion or hemodynamically significant stenosis, and the prompt initiation of appropriate treatment prevent dangerous complications, reduce mortality, and improve prognosis.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Coronary Artery Lesionsmentioning

confidence: 99%

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Coronary artery lesions in Takayasu arteritis

Dzhus,

Mostbauer

2024

Reumatologia

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“…In the field of rheumatology, GCA remains a medical emergency because the patients carry a high risk for visual loss or stroke. Nevertheless, the more silent aortic involvement has the potential for life-threatening complications (aortic aneurism and dissection) that we all should be aware of [ 6 , 7 , 8 , 9 ]. Because long-term medium- and high-dose glucocorticoids are still the mainstay of therapy, disease is also associated with important treatment-related morbidity.…”

Section: Introductionmentioning

confidence: 99%

Current Perspectives in Giant Cell Arteritis: Can We Better Connect Pathogenesis and Treatment?

Opriș-Belinski,

Cobilinschi,

Săulescu

2024

Medicina

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Giant cell arteritis (GCA) is a large-vessel vasculitis affecting elderly patients and targeting the aorta and its main branches, leading to cranial and extracranial manifestations. The mechanism behind the ischemia is a granulomatous-type inflammation with potentially critical lesions, including visual loss involving the ophthalmic artery. Despite significant progress in unraveling the pathophysiology of this disease, treatment options still rely on glucocorticoids (GCs) to overcome active vascular lesions and disease flares. However, uncertainty still revolves around the optimal dose and tapering rhythm. Few corticosteroid-sparing agents have proven useful in GCA, namely, methotrexate and tocilizumab, benefiting cumulative GC dose and relapse-free intervals. The future looks promising with regard to using other agents like abatacept and Janus-kinase inhibitors or blocking the granulocyte–macrophage colony-stimulating factor receptor.

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Etiology and prognosis of non-Kawasaki disease induced coronary aneurysms in children: a retrospective case series study

Lin,

Qi,

Liu

et al. 2024

Eur J Pediatr

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While Kawasaki disease (KD) induced coronary artery aneurysms (KD CAAs) in children are well studied, the features and prognosis of non-KD induced CAAs (non-KD CAAs) in the pediatric population are poorly documented. This case series study is to analyze the etiology and prognosis of non-KD CAAs in children and compare the characteristics of non-KD CAAs and KD CAAs. Non-KD CAA and KD CAA cases at our department from January 2022 to December 2023 were retrospectively collected. Etiologies and prognosis of non-KD CAAs were analyzed. Furthermore, demographic data, biochemical parameters and outcomes between children with Non-KD CAAs and children with KD CAAs were comparatively studied. Fifteen children with non-KD CAAs with a median age of 6 years and 117 children with KD CAAs with a median age of 2.0 years (p = 0.022) were included in this study. The causes of non-KD CAAs include: unknown etiologies (2 cases), coronary artery structural abnormalities (4), Takayasu arteritis (2), virus infection (2), cardiomyopathy (2), aplastic anemia with agranulocytosis (1), ANCA-associated vasculitis (1), and mucopolysaccharidosis (1). In the non-KD CAA group, there were a total of 19 CAAs with 3 being giant, 5 medium, and 11 small; 4 patients had complete CAA regression; an infant with a fistula between the right coronary artery and the coronary sinus complicated with cardiac enlargement died of heart failure. The KD group had significantly higher levels of CRP, white cells counts and ESR with zero mortality. Non-KD CAA cases had a significantly lower regression rate than KD-CAA cases (26.7% vs 66.7%, p = 0.004), and the probability of CAA regression in non-KD patients was 0.341 of that in KD patients (p = 0.006, OR = 0.341, 95% CI: 0.179–0.647).Conclusions: Various etiologies for Non-KD CAAs are identified. Patients with Non-KD CAAs were observed to have lower inflammatory indexes but poorer recovery than patients with KD CAAs. Therapeutic strategies different than those for KD may be needed for non-KD CAAs. What is Known:• Coronary artery aneurysm (CAA) in children is most commonly induced by Kawasaki disease (KD CAA), with a 50 ~ 70% regression rate in 1 to 2 years.• CAA induced by diseases other than KD (non-KD CAA) in children is rare and its prognosis remains largely unknown. What is New:• Most non-KD CAA cases are caused by coronary artery structural malformations.• Non-KD CAA in children has poorer prognosis and lower regression rate compared with KD CAA.• In addition to guideline directed anti-platelet and anti-coagulant therapies, treatments targeting the causal factor are necessary for non-KD CAA.

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Refractory Takayasu’s Arteritis with Severe Coronary Involvement—Case Report and Literature Review

Cited by 5 publications

References 43 publications

Coronary artery lesions in Takayasu arteritis

Coronary artery lesions in Takayasu arteritis

Current Perspectives in Giant Cell Arteritis: Can We Better Connect Pathogenesis and Treatment?

Etiology and prognosis of non-Kawasaki disease induced coronary aneurysms in children: a retrospective case series study

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