Natural history of coronary artery stenosis

Introduction: Moyamoya disease (MMD) is a rare, progressive steno-occlusive disease of the intracranial carotid arteries. This is primarily a cerebrovascular disease and is mostly seen in young Japanese patients. We report a case of severe stenosis in the distal left circumflex artery (dLCx) in a non-Japanese patient with previously diagnosed MMD. Case presentation: A 33-year-old Caucasian female with history of MMD and 2 CVAs presented with chest pain for 2 days. Her only medication at home was aspirin. There was no history of hypertension, diabetes mellitus, or tobacco use. There was no family history of early CAD. Physical examination was positive for tachycardia but negative for carotid or femoral bruits. Neurologic examination revealed decreased touch sensation and diminished deep tendon reflexes on the left side. ECG demonstrated tachycardia with T wave inversions in leads III and ST depression in lead II. Acute CVA was ruled out with an MRI. Cardiac troponins were minimally elevated with peak of 0.12 ng/dl. An initial diagnosis of NSTEMI was made; patient was loaded with aspirin, clopidogrel and started on a heparin drip. Cardiac catheterization on the following day revealed single vessel CAD in the dLCx, with 80% stenosis and TIMI flow 2. A drug eluting stent was successfully placed in the dLCx. Angiogram post-stent placement showed optimal angiographic result with TIMI 3 flow. The patient was discharged home on dual antiplatelet therapy, statin, beta-blocker and ACE inhibitor. Discussion: MMD is thought to affect the coronary arteries from fibrous intimal thickening and histopathology of these coronary lesions show a homogenous, soft intimal proliferation with minimum lipid deposition and without substantial inflammatory cell infiltration. Although the combined involvement of carotid and coronary artery stenosis is rare, coronary involvement should be considered as one of the causes of ischemic heart disease in young patients with MMD. To the best of our knowledge, this is the first reported case of combined involvement of carotid and coronary artery stenosis in a Caucasian patient with previously diagnosed MMD. It is imperative to educate patients with MMD about possible CAD so that they seek immediate medical attention if cardiac symptoms occur.

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Rest perfusion defects in patients with no history of myocardial infarction predict the presence of a critical coronary artery stenosis

Journal of Nuclear Cardiology ◽

10.1016/j.nuclcard.2003.07.002 ◽

2003 ◽

Vol 10 (6) ◽

pp. 656-662 ◽

Cited By ~ 1

Author(s):

F Aboul-Enein

Keyword(s):

Myocardial Infarction ◽

Coronary Artery ◽

Coronary Artery Stenosis ◽

Artery Stenosis ◽

Rest Perfusion ◽

History Of ◽

Perfusion Defects

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STABLE ANGINA

The Professional Medical Journal ◽

10.29309/tpmj/2009.16.01.2989 ◽

2009 ◽

Vol 16 (01) ◽

pp. 94-99

Author(s):

SHAFIQUE AHMED ◽

MUHAMMAD BILAL AHSAN ◽

EHSAN ULLAH ◽

Raees Abbas

Keyword(s):

Coronary Artery ◽

Stable Angina ◽

Coronary Artery Stenosis ◽

Case Series ◽

Artery Stenosis ◽

P Value ◽

Significant Difference ◽

History Of ◽

Male Patients ◽

Artery Disease

Objective: To see the frequency of coronary artery stenosis in the patients of stable angina having left bundle branchblock, and to see the effects of gender and age on this correlation. Design: Experimental case series. Setting: Bahawal Victoria Hospital,Bahawalpur. Period: June 2006 to May 2008. Methods: One hundred and forty one (141) patients of Stable Angina presenting with atypicalchest pain, both male and female of 30—70 years age, positive for LBBB and with normal Cardio-Thoracic Ratio, normal echocardiographyand negative for conventional risk factors and family history of Coronary Artery Disease were taken. All patients were angiographied .Results: A total of 141 patients were investigated through coronary angiogram to see the frequency of coronary artery stenosis in thesepatients. Ninety five (67.4%) patients proved to have coronary artery stenosis. The male patients showed higher frequency (87.4%) ofharboring coronary vessel blockade as compared to that (35.2%) in females (P value <0.0005). There was no relation between age and thefrequency of coronary stenosis (P value >0.05). Conclusions: There is significant difference (P value <0.0005) in coronary artery stenosisamong men and women having LBBB.

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Abstract TP137: The Association Between MRI-detected Carotid Vulnerable Plaque and Coronary Artery Stenosis

Stroke ◽

10.1161/str.47.suppl_1.tp137 ◽

2016 ◽

Vol 47 (suppl_1) ◽

Author(s):

Manabu Nagata ◽

Kazumichi Yoshida ◽

Ryu Fukumitsu ◽

Yohei Takenobu ◽

...

Keyword(s):

Coronary Artery ◽

Carotid Artery ◽

Carotid Artery Stenosis ◽

Carotid Plaque ◽

Coronary Artery Stenosis ◽

Coronary Intervention ◽

Artery Stenosis ◽

Vulnerable Plaques ◽

Carotid Mri ◽

History Of

It is now accepted that carotid artery stenosis should be treated as a part of systemic atherothrombosis. However, little is known about the association in atherosclerosis between the carotid and coronary arteries. We retrospectively investigated the association between carotid plaque vulnerability diagnosed on carotid magnetic resonance imaging (MRI) and coexisting coronary artery stenosis in patients scheduled for carotid endarterectomy (CEA) or carotid artery stenting (CAS). Eighty-nine consecutive cases that underwent carotid reconstruction for carotid artery stenosis at Kyoto University Hospital between 2010 and 2015 were enrolled in this study. Ten cases that received neither coronary angiography (CAG) nor coronary computed tomography angiography (CCTA) as preoperative examinations, 6 cases with restenosis after CEA or CAS, and 2 cases that did not undergo carotid MRI were excluded. We evaluated relative overall signal intensity (roSI) of the carotid plaque on T1-weighted imaging and coronary artery stenosis detected on CAG or CCTA in the remaining 71 cases. Carotid plaques with roSI >1.5 were defined as MRI-detected vulnerable plaques. Thirty-one cases had a history of previous coronary intervention (stenting or bypass surgery), of which 26 (84%) showed carotid vulnerable plaques. In the cases with no history of coronary intervention, coronary artery stenosis was newly detected in 21 cases, and was not demonstrated in the other 19 cases. Fifteen of the 21 cases with coronary artery stenosis (71%) also showed carotid vulnerable plaques. On the other hand, only 4 of the 19 cases without coronary artery stenosis (21%) had carotid vulnerable plaques, representing a significant difference (P<0.05). Among the cases with no history of coronary intervention, prevalence of coronary artery stenosis in cases with carotid vulnerable plaques was 79%, significantly higher than that in cases without carotid vulnerable plaques (29%). In conclusion, this study demonstrated that patients with carotid vulnerable plaques are more likely to have advanced coronary artery stenosis. Plaque characterization by carotid MRI is useful not only for treatment of carotid artery stenosis, but also for predicting coronary artery stenosis.

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Recurrent Event Analysis of Coronary Artery Stenosis in Patients Undergoing Angioplasty

Iranian Red Crescent Medical Journal ◽

10.5812/ircmj.101408 ◽

2020 ◽

Vol 22 (5) ◽

Author(s):

Behrouz Beiranvand ◽

Ebrahim Hajizadeh ◽

Aliakbar Rasekhi ◽

Abdollah Amirfarhangi ◽

Javad Nasseryan

Keyword(s):

Risk Factors ◽

Myocardial Infarction ◽

Coronary Artery ◽

Unstable Angina ◽

Coronary Angioplasty ◽

Coronary Artery Stenosis ◽

Artery Stenosis ◽

Recurrent Event ◽

Recurrent Event Data ◽

History Of

Background: Restenosis after coronary angioplasty can have serious complications such as coronary artery bypass graft, myocardial infarction, and death. Objectives: The present study aimed at investigating the factors affecting the recurrence of coronary artery stenosis in patients undergoing angioplasty using the recurrent event data analysis. Methods: A cohort study was performed on patients undergoing coronary angioplasty from March 23, 2009, to January 21, 2011. All patients were followed up from angioplasty to January 21, 2015. First, each of the independent variables was entered into the univariate Cox model with a frailty component. Then, variables with p-values of less than 0.2 were entered into the multivariate analysis. The statistical analysis was done using R software, version 3.6, at the significance level of 0.05. Results: The present study was conducted on 1,000 patients who underwent coronary angioplasty. We found that 441 patients experienced restenosis at least once in the study period. The mean survival time to the first event of restenosis was 44.08 ± 1.06 months. Patients with a history of diabetes, unstable angina, and myocardial infarction had a significantly higher hazard of restenosis compared to other patients (P < 0.05). Conclusions: The results of the recurrent event survival analysis confirmed the significant role of risk factors such as a history of diabetes, unstable angina, and myocardial infarction. Therefore, training to enhance the patients’ awareness and attitude seems necessary to prevent them from exposing whit known risk factors. The periodic follow-up of patients with risk factors and more ongoing care are also necessary.

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