CASE SUMMARY: We report a 29-year-old woman with Takayasu arteritis and critical left main coronary artery stenosis treated with prednisolone, tocilizumab, and coronary artery bypass grafting. Serial computed tomography angiography over 6 years demonstrated delayed yet marked regression of coronary stenosis despite minimal early change. Improvement occurred during a period of sustained inflammatory control and careful glucocorticoid tapering. No cardiovascular events or relapse occurred, and graft patency was preserved. This case suggests that prolonged suppression of vascular inflammation may be associated with delayed improvement in coronary stenosis in selected patients with Takayasu arteritis. TAKE-HOME MESSAGES: Sustained inflammatory control with long-term tocilizumab therapy and carefully tapered glucocorticoids may be associated with delayed improvement of coronary artery stenosis in Takayasu arteritis. Monitoring inflammatory biomarkers, including interleukin-6 trends when conventional markers are suppressed, may support individualized glucocorticoid tapering strategies.
Arita et al. (Mon,) studied this question.
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