Impact of computed tomography on the diagnosis of Takayasu arteritis with acute coronary syndrome: A case series.

Both the diagnosis and treatment of coronary artery involvement with Takayasu arteritis (TA) are challenging. In this study, we report different clinical scenarios of two TA cases without Typical symptoms of TA that initially presented in the form of acute coronary syndrome (ACS). Patient 1 was a 24-year-old Japanese woman without coronary risk factors who presented with exertional chest pain, dyspnea, and syncope. Invasive coronary angiography (ICA) revealed a considerable lesion of the right coronary artery and the left main trunk. Ventricular fibrillation was observed immediately after the procedure. Despite conventional treatment, she died on day 16. Patient 2 was a 34-year-old Japanese woman without coronary risk factors who developed cardiogenic shock during a treadmill test for exertional chest pain. Coronary computed tomography angiography confirmed severe left main stenosis, presenting as ACS caused by TA. She was started on steroid therapy before coronary artery bypass grafting, resulting in a good postoperative course and no recurrence of chest pain. Therefore, coronary computed tomography angiography likely is useful for the early diagnosis of TA in young women with typical chest symptoms of ACS. It may help in avoiding complications associated with ICA. Learning objective: When young women with a low pre-test probability of coronary artery disease present with typical anginal symptoms, Takayasu arteritis (TA) should be suspected despite the absence of symptoms such as fever, fatigue, or myalgia. Coronary computed tomography angiography is safe for rapid diagnosis and decision-making when patients suspected of having TA initially manifest an unstable condition such as acute coronary syndrome.