Case Report - Journal of Pharmaceutical Research and Clinical Practice (2023) Volume 6, Issue 1
A Short Note on the Coronary Arteritis: Coronary Vasculitis
Department of Anthropology, University of Alabama at Birmingham, Birmingham, AL 35294, USA
Department of Anthropology, University of Alabama at Birmingham, Birmingham, AL 35294, USA
Received: 01- February- 2023, Manuscript No. jprcp-23-88939; Editor assigned: 03- February- 2023, PreQC No. jprcp-23-88939 (PQ); Reviewed: 17- February- 2023, QC No. jprcp-23-88939; Revised: 22- February- 2023, Manuscript No. jprcp-23-88939 (R); Published: 28-February- 2023; DOI: 10.37532/ jprcp.2023.6(1).13-15
A wide variety of diseases with a diverse range of symptoms and severity are referred to as coronary “artery vacuities.” Due to involvement of the coronary microvasculature, stenosis, aneurysm, or spontaneous dissection of large coronaries, as well as vascular thrombosis, clinical manifestations may include pericarditis or myocarditis. Patients with coronary artery vacuities are typically younger and progress their disease more quickly than those with common atherosclerosis. Kawasaki’s disease, Takayasu’s arteritis, polyarteritis nodosa, ANCA-associated vacuities, giant-cell arteritis, and most recently a Kawasaki-like syndrome associated with SARS-COV-2 infection have all been linked to coronary artery vacuities. For the practicing cardiologist, this review will provide a brief description of these conditions, as well as their diagnosis and treatment. A rare but devastating complication of giant cell arteritis, also known as temporal arteritis, is coronary vacuities. It is now recognized that it frequently affects a number of medium and large arteries throughout the body, despite the fact that it was initially given its name for its propensity to attack the superficial temporal arteries. Here, we describe two cases of coronary artery giant cell arteritis, one of which was discovered at the post-mortem and one of which was successfully treated with drug-eluting coronary stents and immunosuppressive therapy.
Giant cell arteritis • Coronary artery disease • Coronary stenting • coronary artery disease • Vacuities • Mortality
A group of conditions whose pathophysiology is mediated by blood vessel inflammation are referred to as vacuities [1, 2]. A multidisciplinary approach is required because the majority of forms of vasculitis are systemic and may have varying clinical manifestations. Numerous causes have been identified; Vacuities can be caused by another autoimmune disease (primary or secondary) or by other precipitants like drugs, infections, or cancer, regardless of which organ is involved. Systemic vacuities, which are categorized according to the type and size of the affected vessels as well as the cellular component that is responsible for the tissue infiltration, manifest in nearly all cases of coronary vasculitis. The following groups of vacuities are distinguished by the classifications of the American College of Rheumatology and the Chapel Hill International Consensus Conference .
The medium-to-large vessel vasculitis known as giant cell arteritis (GCA), also referred to as temporal arteritis, affects people over the age of 50. Computerized tomographic (CT) angiography has demonstrated involvement of other large arteries (particularly the aorta, brachiocephalic trunk, carotid arteries, subclavian arteries, and femoral arteries) in up to two thirds of patients, despite its traditional preference for the temporal arteries. Coronary arteritis is a potential and well-known complication of Takayasu arteritis and has traditionally been associated with medium and small vessel vasculitis, such as Kawasaki disease. However, there have been a few reports of coronary arteritis caused by GCA; the majority of these cases were associated with fatal myocardial infarctions and included autopsy evidence of coronary GCA. Bare metal stents have been used to treat GCA involving the coronary arteries. In cases of GCA affecting the subclavian, axillary, brachial, renal, and vertebral arteries, stenting has also been used successfully.
One case of critical coronary artery stenosis in acute GCA that was only discovered at postmortem and the first to be successfully vascularized with drug-eluting stents is described in this paper .
Young females are more likely to develop Takayasu Takayasu arteritis, which affects large blood vessels such as the pulmonary arteries and the aortic arch. Typically, the disease progresses over time and causes cutaneous, neurologic, gastrointestinal, and general symptoms. In 10–45% of cases, coronary artery ostial stenosis from aortitis or coronary arteritis results in angina pectoris, which can have severe clinical squeal, despite the possibility of regression with immunosuppression? The diffusion of the inflammatory process and intimal proliferation from the ascending aorta wall result in coronary artery stenosis in these instances. Cell-mediated mechanisms, particularly those of cytotoxic lymphocytes and gamma delta T lymphocytes that release the cytolytic protein perforin, are thought to be involved in the unknown pathogenesis. The disease’s selective localization may be explained by the presence of a particular antigen in the aorta. Mononuclear cells, primarily lymphocytes, histiocytes, macrophages, and plasma cells, are present in histology, and the arterial media contains giant cells and granulomatous inflammation. The expansion of these inflammatory processes may result in either a narrowing of the lumen or the destruction of the elastic lamina on one side, resulting in the aneurysmal dilation of the affected vessel. Frequently, systemic inflammatory markers are elevated. Corticosteroids and immunosuppression make up systemic treatment, but anti-IL6 treatment with Tocilizumab has also been linked to a decrease in inflammation markers and, more importantly, in the number of coronary artery lesions. With remissions and relapses, Takayasu is a progressive chronic disease with a five-year survival rate of 80–90 percent.
Coronary GCA is a condition that can be fatal but is uncommon. Coronary arteritis should be considered in an older patient with acute cardiovascular disease and elevated inflammatory markers or GCA-like clinical features. In contrast, when treating a patient with known GCA, the differential diagnosis for new-onset cardiac symptoms must include coronary vacuities [5, 6].
Even though Case A demonstrates without a doubt that GCA can affect the coronary arteries, the literature to date does not support a populationwide link between GCA and cardiovascular disease. Aortic dissection/aneurysm, myocardial infarction (MI), stroke, and peripheral vascular disease have all been linked to GCA, possibly as a result of vasculitis directly attacking the coronary, cerebral, or peripheral circulation, or as a generalized inflammatory state accelerating the underlying atherosclerosis. Because GCA is a rare condition, it is difficult to adequately power prospective studies for cardiovascular endpoints. However, a 2015 systematic review of six studies found no statistically significant increase in the risk of coronary artery disease associated with GCA . However, the analysis had high statistical heterogeneity (I2 = 97 percent), primarily as a result of differences in the definition of coronary artery disease. Additionally, older individuals with GCA have a higher baseline risk of coronary atherosclerosis. Additionally, treatment with corticosteroids may theoretically lower cardiovascular risk due to its anti-inflammatory effects or may independently increase cardiovascular risk by causing hyperglycaemia, hypertension, and hyperlipidaemia [7, 8].
Systemic necrotizing vasculitis known as polyarteritis nodosa mostly affects arteries of medium size, but it can also affect small muscular arteries in middle-aged adults. Polyarteritis nodosa, in contrast to microscopic polyarteritis, granulomatosis, and polyangiitis, lacks antineutrophil cytoplasmic antibodies (ANCA). It can affect virtually any organ in the body, including the kidneys, skin, joints, muscles, nerves, and gastrointestinal tract. Most of the time, it affects multiple organs at once, but it rarely affects the lungs. Although coronary involvement is thought to be uncommon, it can be severe, such as aggressive three-vessel disease with fatal consequences. Arrhythmias, pericarditis, and congestive heart failure are some of the clinical consequences of this involvement. A coronary stenosis, occlusion, aneurysm, or dissection are all possible manifestations of coronary involvement . From 32 publications, 34 patients with an average age of 41 were identified in a recent case review. The clinical course of polyarteritis nodosa was generally very severe, with cases of death from cardiac arrest, pulmonary edema with alveolar hemorrhage, or multiple intracranial hemorrhages after thrombolytic therapy. Male sex is more common, and coronary disease was the first manifestation of polyarteritis nodosa in 34. It is thought that the inflammatory response is mediated by the formation of immune complexes following a virus infection and hairy cell leukemia. These complexes typically result in media thickening and stenosis rather than the formation of an aneurysm. Cyclophosphamide, corticosteroids, and/or azathioprine are all components of medical treatment, though it appears that this strategy has limited long-term efficacy. The 5-year survival rate is 80%.
Eosinophilic Angiitis Anti-neutrophil cytoplasmic antibody (ANCA)-associated vasculatures are a group of severe, systemic, small-vessel vasculitis caused by autoantibodies that are directed against leukocyte proteinase 3 or myeloperoxidase, respectively, in neutrophils. Recent research has examined their clinical presentation and treatments . Eosinophilia granulomatosis with polyangiitis is a group of diseases in which coronary arteries are most frequently involved. The incidence of this condition, which is not always mediated by ANCA, ranges from 0.5–2 cases per million per year. It typically begins in middle age or older and affects both men and women equally. It is histologically characterized by necrotizing granulomatous inflammation that is eosinophil-rich and primarily affects small to medium vessels; The typical sign is eosinophilia, and pulmonary involvement and asthma are frequently linked. The first case of a novel medium- sized arteritis with eosinophilia and inflammation limited to the adventitia and per adventitial soft tissue of pericardial coronary arteries was reported in 1989, though it did not overlap with this condition. In contrast to polyarthritis nodosa and Churg–Strauss Syndrome, eosinophilia coronary per arteritis is not systemic and does not involve other arterial layers nor exhibit fibroid necrosis. Adult-onset cases of spontaneous coronary artery dissection or coronary spasm have been linked to this type of coronary artery vacuities .
In the absence of acute end-organ ischemia, these high rates may support the early implementation of immunosuppression and a trial of medical treatment. Drug-eluting stents, when used in conjunction with immunosuppression, may be effective in the short- and long-term treatment of unstable acute coronary GCA, as demonstrated by the absence of coronary events for a full year after revascularization in Case B.
Despite its rarity, coronary artery vasculitis is still one of the most common causes of coronary artery disease in young patients. Coronary artery stenosis, aneurysms, thrombosis, and spontaneous dissection are examples of its anatomical manifestations. And it may have serious repercussions. Even though coronary vasculitis has a poor prognosis, early diagnosis and treatment increase survival rates. Both non-invasive and invasive techniques provide crucial diagnostic data. To further investigate the incidence, diagnostic yield, and treatment of this diverse and rare group of diseases, large-scale studies are now required.
Conflict of Interest
- NamdaroÄlu S, Tekgündüz E, BozdaÄ SC et al. Microbial Contamination of Hematopoietic Progenitor Cell Products.Transfus Apher Sci.48, 403–406 (2013).
- Wang S, Sun J, Chen K et al. Perspectives of Tumor-Infiltrating Lymphocyte Treatment in Solid Tumors.BMC Med.19, 140-146 (2021).
- Eshhar Z, Waks T, Gross G et al. Specific Activation and Targeting of Cytotoxic Lymphocytes through Chimeric Single Chains Consisting of Antibody-Binding Domains and the Gamma or Zeta Subunits of the Immunoglobulin and T-Cell Receptors.Proc Natl Acad Sci.90, 720–724(1993).
- Harwood CR. Bacillus subtilis and its relatives: Molecular biological and industrial workhorses. Trends Biotechnol. 10, 247-252 (1992).
- Young EJ. Engineering the Bacterial Microcompartment Domain for Molecular Scaffolding Applications. Front Microbiol. 8, 1441-1445(2017).
- Liu Y. Pathway engineering of Bacillus subtilis for microbial production of N-acetylglucosamine. Metab Eng. 19, 107–115 (2013).
- Panahi R. Auto-inducible expression system based on the SigB-dependent ohrB promoter in Bacillus subtilis. Mol Biol.48, 852–857(2014).
- Feng Y. Enhanced extracellular production of L-asparaginase from Bacillus subtilis 168 by B. subtilis WB600 through a combined strategy. Appl Microbiol Biotechnol. 101, 1509–1520 (2017).
- Schallmey M, Singh A, Ward OP. Developments in the use of Bacillus species for industrial production. Can J Microbiol.50, 1–17(2004).
- Perkins J. Genetic engineering of Bacillus subtilis for the commercial production of riboflavin. J Ind Microbiol Biotechnol. 22, 8–18(1999).