Title : Premature and accelerated atherosclerosis in an undiagnosed takayasu arteritis: A case report
Takayasu arteritis (TA) is a rare chronic vasculitis affecting the aorta and its main branches causing segmental and granulomatous inflammation. The underlying inflammatory process associated with the disease is believed to be an important risk factor in in atherogenesis causing accelerated atherosclerosis in these patients. As a result, patients with Takayasu arteritis experience long-term morbidity and mortality caused by cardiovascular disease. Described here is a patient who presented with premature cardiovascular events, and was recently found to have fulfilled the diagnostic criteria for Takayasu arteritis.
The patient is a 56 year-old Asian female who had a history of stroke in the young, abdominal aortic stenosis status post stenting, and premature coronary artery disease status post coronary artery bypass graft and repeated coronary angioplasty. During her surveillance check-up, left arm claudication was reported and discrepant blood pressures on both arms were detected. Acute phase reactants (ESR and CRP) were elevated. Carotid ultrasound revealed homogenous, midechoic circumferential wall thickening superimposed with diffuse atherosclerotic plaques on both carotid arteries. Arterial Doppler of the upper extremities demonstrated a totally occluded left subclavian artery with formation of collaterals. After satisfying the criteria for the diagnosis of Takayasu arteritis, she was referred to a rheumatologist who started her on glucocorticoids and azathioprine. The premature ischemic events experienced by our patient are believed to be complications of an undiagnosed Takayasu arteritis.
Patients with Takayasu arteritis are at increased risk for cardiovascular events due to premature and accelerated atherosclerosis. A high index of suspicion is imperative to make an early diagnosis and initiate appropriate treatment to prevent serious long-term complications.
Audience take away:
- The evolution of symptoms in Takayasu arteritis is due to progressing vascular lesions secondary to inflammatory processes.
- Inflammation has a fundamental role in the development of premature and accelerated atherosclerosis in Takayasu arteritis. This eventually causes ischemic complications.
- Stroke in the young and premature coronary artery disease can be manifestations of Takayasu arteritis.
- A high index of suspicion is essential to avoid serious long-term complications.