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.