ArticleJACC. Case reports2026
Chronic Total Occlusion Recanalization in a 14-Year-Old Girl With Pseudoxanthoma Elasticum: IVUS-Guided Stentless Strategy.
Article in JACC. Case reports, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
backgroundPseudoxanthoma elasticum (PXE) is a hereditary disorder causing progressive arterial mineralization that may cause premature coronary disease in children. CASE SUMMARY: A 14-year-old girl with exertional angina since age 8 was diagnosed with PXE after her mother used an artificial intelligence tool to identify skin lesions. Coronary imaging revealed mid-left anterior descending artery chronic total occlusion without CT macrocalcification. Intravascular ultrasound (IVUS) demonstrated concentric high-echoic wall thickening without acoustic shadowing, consistent with mineralized elastic lamina rather than atherosclerosis. A stentless drug-coated balloon strategy was chosen. At 10 months, she was asymptomatic with sustained left anterior descending artery patency by scheduled angiography. DISCUSSION: This is the first reported IVUS-guided chronic total occlusion recanalization in a pediatric PXE patient, illustrating how intravascular imaging can characterize disease biology and guide individualized device selection. TAKE-HOME MESSAGES: In children with unexplained exertional symptoms and skin lesions, PXE should be considered. When IVUS identifies a nonatherosclerotic substrate, a stentless strategy may preserve vessel growth potential.
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