Shifting perspectives in coronary involvement of polyarteritis nodosa: case of 3-vessel occlusion treated with 4-vessel CABG and review of literature. [Review] 

 -  2024 
<br/><br/>Available online from MWHC library: 2001 - present 
<br/><br/> BACKGROUND: Polyarteritis Nodosa (PAN) is a systemic vasculitis (SV) historically thought to spare the coronary arteries. Coronary angiography and contemporary imaging reveal coronary stenosis and dilation, which are associated with significant morbidity and mortality. Coronary arteries in PAN are burdened with accelerated atherosclerosis from generalized inflammation adding to an inherent arteritic process. Traditional atherosclerotic risk factors fail to approximate risk. Few reports document coronary pathology and optimal therapy has been guarded.  CONCLUSIONS: When graft selection avoids the vascular territory of SV's, CABG offers definitive therapy. We have contributed report of a novel CABG configuration in addition to reviewing, updating and discussing the literature. Accumulating evidence suggests discrete clinical symptoms warrant suspicion for coronary involvement. Copyright © 2024. The Author(s).  METHODS: Database publication query of English literature from 1990-2022.  RESULTS: Severity of coronary involvement eludes laboratory monitoring, but coronary disease associates with several clinical symptoms. Framingham risk factors inadequately approximate disease burden. Separating atherosclerosis from arteritis requires advanced angiographic methods. Therapy includes anticoagulation, immunosuppression and revascularization. PCI has been the mainstay, though stenting is confounded by vagarious alteration in luminal diameter and reports of neointimization soon after placement. 
<br/><br/><br/>English 
<br/><br/><label>ISSN: </label>1471-2261 
<br/><br/><label>Standard No.: </label>10.1186/s12872-024-03841-y [pii] PMC10985918 [pmc] 
<br/><br/><label>Subjects--Topical Terms: </label><br/>*Atherosclerosis<br/>*Coronary Artery Disease<br/>*Percutaneous Coronary Intervention<br/>*Polyarteritis Nodosa<br/>Atherosclerosis/et [Etiology]<br/>Coronary Artery Bypass<br/>Coronary Artery Disease/dg [Diagnostic Imaging]<br/>Coronary Artery Disease/et [Etiology]<br/>Coronary Artery Disease/th [Therapy]<br/>Humans<br/>Percutaneous Coronary Intervention/mt [Methods]<br/>Polyarteritis Nodosa/co [Complications]<br/>Polyarteritis Nodosa/dg [Diagnostic Imaging]<br/>Polyarteritis Nodosa/th [Therapy]<br/>Treatment Outcome--Curated
<br/><br/><label>Subjects--Geographic Terms: </label><br/>MedStar Heart & Vascular Institute<br/>MedStar Washington Hospital Center
<br/><br/><label>Index Terms--Occupation: </label><br/>Cardiovascular Disease Fellowship<br/>Internal Medicine Residency<br/>MedStar Georgetown University Hospital/MedStar Washington Hospital Center
<br/><br/><label>Index Terms--Function: </label><br/>Case Reports<br/>Journal Article<br/>Review