Background There is controversy surrounding the prevalence of abnormalities of the coronary arteries (CA) in TA. A Japanese institute (1) reported 38.3% of CA involvement in TA. Sun T. et al. (2) estimated the prevalence of CA lesions at 7, 7% in 587 patients hospitalized with TA.
Objectives To investigate the variants of pathological findings in the coronary arteries in autopsy cases of TA.
Methods Microscopic examinations of the coronary arteries were performed in sixty fatal cases (52 men and 8 women aged 18 to 45 years) of TA over period of 11 years. The median age at disease onset was 25, 7 years.
Results The second-leading cause of death from TA was acute heart failure due to myocardial infarction (25%). Pathological changes in the coronary arteries have been found in 46 cases (76, 7%) of TA. The predominant lesions were on the coronary orifices, or more rarely, in the proximal parts of CA. The most remarkable finding was intimal hyperplasia consists of areas of musculo-fibrous proliferation or multi-layer scleral hyaline plaques. This pillow-like thickening of the intima around of the coronary orifices leads to their luminal narrowing. No morphological abnormalities were observed in the distal parts of CA. In the studied material we found the features of granulomatous arteritis with diffuse or focal infiltration of lymphocytes, plasma cells, histiocytes. Infiltrate being preferentially located in the medio-adventitial junction and also around the vasa vasorum of the adventitia. Contrary to other studies giant cell granulomatous reaction has not been detected in any specimen. Complete obliteration of the arterial lumen with recanalization of organized thrombi has been presented in 13 cases of TA complicated by fatal acute myocardial infarction. Coronary atherosclerosis of varying severity was observed in 35 cases (58, 3%). The most common location of atherosclerotic deposits was regions of the pillow-like thickening of the intima around of the coronary orifices. In two patients, a 30-year-old man and a 35-year-old man, typical for TA changes accompanied by severe atherosclerotic narrowing of the coronary arteries resulted in a fatal myocardial infarction.
Conclusions Our date show high frequency (76, 7%) of pathological changes of CA in TA. It can be assumed that intimal hyperplasia, granulomatous arteritis, and coronary atherosclerosis are typical lesions of CA in TA. The coronary orifices are the site most commonly affected by TA. Luminal narrowing of CA with coronary flow reduction led to subsequent fatal myocardial infarction in 15 cases (25%). High prevalence of coronary atherosclerosis in TA (58, 3%) may be regarded as accelerating the atherosclerotic process due to chronic autoimmune inflammation in CA. In addition, it should be noted that in our series of autopsy cases of TA, males (86, 7%) were most frequently affected compared with results other investigations.
Endo M, Tomizawa Y, Nishida H, Aomi S, Nakazawa M, Tsurumi Y, Kawana M, Kasanuki H. Angiographic findings and surgical treatments of coronary artery involvement in Takayasu arteritis. J Thorac Cardiovasc Surg 2003; 125: 570–577.
Sun T, Zhang H, Ma W, Yang L, Jiang X, Wu H, Hui R, Zheng D. Coronary artery involvement in Takayasu arteritis in 45 Chinese patients. J Rheumatol 2013; 40(4):493–497.
Disclosure of Interest None declared