Call for CASES

One Stage Coronary And Peripheral Intervention (OCAPI) in a patient with accelerated diffuse atherosclerosis after

chest irradiation.

One Stage Coronary And Peripheral Intervention (OCAPI) in a patient with accelerated diffuse atherosclerosis after

chest irradiation.

PAWEL BUSZMAN, MD, FESC, FSCAIAmerican Heart of Poland, Ustron, Poland

Upper-Silesian Heart Center, Silesian Medical School, Katowice, Poland

PAWEL BUSZMAN, MD, FESC, FSCAIAmerican Heart of Poland, Ustron, Poland

Upper-Silesian Heart Center, Silesian Medical School, Katowice, Poland

Introduction

• Therapeutic ionizing radiation to the chest and neck is used to prevent local recurrence of breast, larynx and thyroid cancer, to improve disease control in lung and esophagal cancer, as well as to improve the cure rate with Hodgkin and non-Hodgkin lymphoma of the mediastinum.

• Essentially, all cardiac structure (pericardium, myocardium, coronary arteries) and peripheral vessels may be affected by such efforts.

• Accelerated coronary and peripheral artery narrowing results from chest and neck irradiation and may lead to serious clinical consequences.

• Therapeutic ionizing radiation to the chest and neck is used to prevent local recurrence of breast, larynx and thyroid cancer, to improve disease control in lung and esophagal cancer, as well as to improve the cure rate with Hodgkin and non-Hodgkin lymphoma of the mediastinum.

• Essentially, all cardiac structure (pericardium, myocardium, coronary arteries) and peripheral vessels may be affected by such efforts.

• Accelerated coronary and peripheral artery narrowing results from chest and neck irradiation and may lead to serious clinical consequences.

Description of the problem

Patient: 44 year old female

Symptoms: disiness, syncope, chest pain (CCS class 2)Risk factors: familly history of CAD, hypercholesterolaemiaMedical history: non-Hodgkin lymphoma diagnosed and

treated with irradiation of chest 5 years ago.

UKG: normal LV function, normal valves morphology.Stress test: positive.USG(Doppler/Duplex): bilateral narrowing of subclavian

arteries (40-50%), non-significant bilateral lesions in ICA/CCA, small diameter of VAs.

Patient: 44 year old female

Symptoms: disiness, syncope, chest pain (CCS class 2)Risk factors: familly history of CAD, hypercholesterolaemiaMedical history: non-Hodgkin lymphoma diagnosed and

treated with irradiation of chest 5 years ago.

UKG: normal LV function, normal valves morphology.Stress test: positive.USG(Doppler/Duplex): bilateral narrowing of subclavian

arteries (40-50%), non-significant bilateral lesions in ICA/CCA, small diameter of VAs.

Description of the problem

Coronary and peripheral artery angiography:

LCA

Left SCA

Left VARight VA

Right SCA

LCA: LM- ref. diam. 2.3mm, 75% ostial stenosisLAD-80% ostial lesion, 70% prox/med lesion

Left SCA: long 30-40% proximal lesionLeft VA: ostial 80-90% lesionRight SCA: proximal 60% lesion

(gr.<10mmHg)Right VA: 99% ostial lesion

Intended strategyOne Stage Coronary And Peripheral Intervention

• Direct stenting to LM/prox LAD followed by kissing postdilatation LM/LAD/Cx

• Direct stenting of ostial lesions in left and right VAs.

• Coronary technique and equipment for both coronary and peripheral intervention.

• Equipment:Guiding catheter: Louncher Judkins Left 4, 6FGuidwires: 2xBMW 0,014”Taxus stent 3.0x32mm for LM/LAD stentingExpress 3.5x8mm for left VAExpress stent 2.5x8mm for right VABalloon catheters Viva 3.5x20, 3.25x20

Result: LCA after PCI

LCA RAO 30: final result

Kissing postdilatation:LM/LAD 3.5x20LM/Cx 3.25x20mm14 atm, 20 sec.

Result: Vertebral Arteries post PTA

Guiding catheter Left Judkins 4, 6F (Launcher)in right and left subclavian artery for stent delivery to left and right VA.

Guiding catheter Left Judkins 4, 6F (Launcher)in right and left subclavian artery for stent delivery to left and right VA.

Express 2.5x8 Express 3.5x8

•Dye: 150 ml Ultravist

•Procedure time: 1h:15min.

•Fluoroscopy time: 16 min.

•No complication; Hospital stay: 2 days

Novel approche:Novel approche:

Conclusions

• Chest irradiation for treatment of neoplastic disease may cause serious damage to coronary and peripheral arteries. A routine evaluation of heart and peripheral arteries after chest irradiation should be mandatory.

• OCAPI is feasible and cost effective treatment of concomitant coronary and peripheral artery disease. Especially patients with accelerated artery disease after irradiation are good candidates for such procedure.

• Chest irradiation for treatment of neoplastic disease may cause serious damage to coronary and peripheral arteries. A routine evaluation of heart and peripheral arteries after chest irradiation should be mandatory.

• OCAPI is feasible and cost effective treatment of concomitant coronary and peripheral artery disease. Especially patients with accelerated artery disease after irradiation are good candidates for such procedure.