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A 34 year old man presented with a five month history of exertional chest discomfort on moderate exercise. He had no significant coronary risk factors. A diagnosis of Takayasu’s arteritis had been made three years before when he had undergone aortic arch replacement for his thoracic aortic aneurysm. Multislice computed tomography (left anterior oblique view depicting severe ostial stenosis of both right (RCA) and left (LCA) coronary arteries) revealed severe ostial disease of both right and left coronary arteries. A conventional aortocoronary angiogram was compatible with this finding. Elective coronary bypass grafting was subsequently performed successfully.
On the basis of postmortem examinations the incidence of coronary arterial lesions in Takayasu’s arteritis has been reported at approximately 10%. Lesions are most commonly confined to the ostial and proximal portions of the coronary arteries. In cases having this type of coronary involvement, an imprudent selective coronary angiography or maximum exercise test should be avoided. When chest symptoms are observed in this disorder, this non-invasive imaging modality may be the first choice before invasive and risky tests.