Call for CASES

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Call for CASES

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

PAWEL BUSZMAN, MD, FESC, FSCAI American Heart of
Poland, Ustron, Poland Upper-Silesian Heart
Center, Silesian Medical School, Katowice, Poland
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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.

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Description of the problem

• Patient 44 year old female
• Symptoms disiness, syncope, chest pain (CCS
  class 2)
• Risk factors familly history of CAD,
  hypercholesterolaemia
• Medical 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.

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Description of the problem

• Coronary and peripheral artery angiography

Left VA
Right VA
Right SCA
Left SCA
LCA
Left SCA long 30-40 proximal lesion Left VA
ostial 80-90 lesion Right SCA proximal 60
lesion (gr.lt10mmHg) Right VA 99 ostial lesion
LCA LM- ref. diam. 2.3mm, 75 ostial
stenosis LAD-80 ostial lesion, 70 prox/med
lesion
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Intended strategy

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

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Result LCA after PCI
Kissing postdilatationLM/LAD 3.5x20 LM/Cx
3.25x20mm 14 atm, 20 sec.
LCA RAO 30 final result
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Result Vertebral Arteries post PTA

• Dye 150 ml Ultravist
• Procedure time 1h15min.

• Fluoroscopy time 16 min.
• No complication Hospital stay 2 days

Express 2.5x8
Express 3.5x8
Guiding catheter Left Judkins 4, 6F (Launcher)in
right and left subclavian artery for stent
delivery to left and right VA.
Novel approche
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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.