# Takayasu Arteritis–Induced Acute Myocardial Infarction: Coronary Imaging- and Physiology-Guided Management

## TL;DR

A young woman with a heart attack was found to have Takayasu arteritis, and imaging and physiological tests helped avoid unnecessary stenting.

## Contribution

Demonstrates the use of IVUS and FFR in diagnosing vasculitis-induced MI and guiding conservative treatment.

## Key findings

- IVUS and FFR identified vasculitic changes in a young patient with MI.
- Stenting was avoided in favor of immunosuppressive therapy based on imaging and physiology.
- The patient remained asymptomatic after 2 months of conservative management.

## Abstract

Myocardial infarction (MI) in young women may result from vasospasm, spontaneous coronary artery dissection, vasculitis, or plaque rupture. These etiologies are not always distinguishable on coronary angiography alone, necessitating additional intravascular imaging.

A 25-year-old woman presented with non–ST segment elevation MI and was found to have proximal left anterior descending artery occlusion. Intravascular ultrasound (IVUS) revealed features suggestive of Takayasu arteritis, which was confirmed through further work-up. Based on IVUS and fractional flow reserve (FFR) findings, stenting was deferred. She was started on immunosuppressive therapy and remained asymptomatic at 2-month follow-up.

Multimodality assessment using IVUS together with physiologic evaluation by FFR was critical in identifying vasculitic changes and guiding a conservative interventional strategy. Long-term management focused on immunosuppression to control disease activity.

In young women with MI, nonatherosclerotic causes should be considered. IVUS and FFR can aid diagnosis and help avoid unnecessary coronary intervention.