Development of coronary artery disease in a young patient with Takayasu's arteritis: the lesser, the better

Large vessel vasculitis, such as Takayasu's arteritis (TA), is a rare inflammatory disease affecting multiple vascular districts including the coronary arteries, producing either stenosis and/or aneurysms: these le-sions can be found in the same patient and also in the same vessel, with potentially devastating effects. Moreover, TA often affects young people, in the midst of their work and social activity. Ischemic heart disease is the leading cause of cardiovascular mortality in Western countries and is mainly due to coronary atherosclerosis, whose etiopathogenesis is multifactorial and is closely related to the concomitant presence of classic cardiovascular risk factors and inflammation of the vessel wall. We report the case of a young, physically active adult with multivessel coronary artery disease developed in the context of a TA bursted 7 years before and currently in clinical remission. This complex case required a careful literature review and a multidisciplinary approach, since the best treatment option for coronary lesions induced by TA has not been established: a "watchful waiting" strategy was eventually adopted, considering the poor outcome of both percutaneous and surgical revascularization in this group of patients.