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Case images: Takayasu's arteritis with left main stem stenosis of single coronary artery.

Takayasu’s arteritis is a chronic vasculitis involving the aorta and its main branches, pulmonary arteries, and coronary tree. Coronary involvement may appear in up to one-third of patients with Takayasu’s arteritis. Occlusion of the ostia of the left main coronary artery and of proximal segments of the coronary arteries is the most frequent finding of the coronary vasculature in patients with Takayasu’s arteritis. A 58-year-old male patient with Takayasu’s arteritis admitted to our hospital with atypical chest pain. On the physical examination, there was no palpable pulse of the left radial artery, and a right-sided systolic carotid bruit was identified. Due to positive ischemic response to exercise and his physical examination findings, we decided to perform coronary angiography and aortography, which showed total occlusion of the left subclavian artery (white arrows in Figures A and C) and severe stenosis of the right brachiocephalic artery (black arrows in Figures A and B), with a normal left carotid artery giving collateral arteries to the left subclavian artery. On coronary angiogram, the left main coronary arterial stenosis (black arrows in Figures D and F) and a single coronary artery with anomalous origin of the right coronary artery from the mid left anterior 221