title: Takayasu arteritis presenting with total occlusion of the left main coronary artery ostium: an extremely rare occurrence.
abstract: A young 18-year-old female patient with exertional angina and claudication of the upper limbs was subjected to angiography. Bruits were auscultated over the bilateral renal arteries, right subclavian and right common carotid arteries. There was asymmetry of peripheral pulses. Laboratory parameters demonstrated a high erythrocyte sedimentation rate and C reactive protein. An aortic angiogram revealed a typical picture of Takayasu arteritis with bilateral subclavian, common carotid and renal involvement. A coronary angiogram was performed which showed total occlusion of the left main coronary artery. There was retrograde filling of the left coronary artery on right coronary artery injection up to the ostium of the left main coronary artery. Since the markers for disease activity were high, the patient was started on steroids and urgent coronary artery bypass grafting was planned. Unfortunately, the patient refused urgent intervention and was later lost to follow-up. This case describes an extremely rare occurrence of total occlusion of the left main coronary artery ostium in a patient with Takayasu arteritis.
authors.affiliation: Department of Cardiology, Indira Gandhi Medical College, Shimla, Himachal Pradesh, India.
authors.forename: Arvind
authors.initials: A
authors.lastname: Kandoria
authors.affiliation: Department of Obstetrics and Gynaecology, Indira Gandhi Medical College, Shimla, Himachal Pradesh, India.
authors.forename: Meenakshi
authors.initials: M
authors.lastname: Kandoria
authors.affiliation: Department of Cardiology, Indira Gandhi Medical College, Shimla, Himachal Pradesh, India.
authors.forename: Neeraj
authors.initials: N
authors.lastname: Ganju
authors.affiliation: Department of Cardiology, Indira Gandhi Medical College, Shimla, Himachal Pradesh, India.
authors.forename: Kunal
authors.initials: K
authors.lastname: Mahajan
mesh_terms: D000293:Adolescent; D060050:Angina, Stable / Q000000981:diagnostic imaging / Q000209:etiology; D001027:Aortography; D017536:Carotid Artery, Common / Q000000981:diagnostic imaging / Q000503:physiopathology; D017023:Coronary Angiography; D003324:Coronary Artery Disease / Q000000981:diagnostic imaging / Q000209:etiology*; D054059:Coronary Occlusion / Q000000981:diagnostic imaging / Q000209:etiology*; D005260:Female; D006801:Humans; D007383:Intermittent Claudication / Q000000981:diagnostic imaging / Q000209:etiology; D059012:Lost to Follow-Up; D013625:Takayasu Arteritis / Q000150:complications* / Q000000981:diagnostic imaging; D034941:Upper Extremity / Q000098:blood supply / Q000000981:diagnostic imaging