Transcript Diapositive 1

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
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.
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.
Description of the problem
Coronary and peripheral artery angiography:
Left VA
Right VA
Right SCA
Left SCA
LCA
LCA:
LM- ref. diam. 2.3mm, 75% ostial stenosis
LAD-80% ostial lesion, 70% prox/med lesion
Left SCA: long 30-40% proximal lesion
Left VA: ostial 80-90% lesion
Right SCA: proximal 60% lesion
(gr.<10mmHg)
Right VA: 99% ostial lesion
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.
• Equipment:
Guiding catheter: Louncher Judkins Left 4, 6F
Guidwires: 2xBMW 0,014”
Taxus stent 3.0x32mm for LM/LAD stenting
Express 3.5x8mm for left VA
Express stent 2.5x8mm for right VA
Balloon catheters Viva 3.5x20, 3.25x20
Result: LCA after PCI
Kissing postdilatation:
LM/LAD 3.5x20
LM/Cx 3.25x20mm
14 atm, 20 sec.
LCA RAO 30: final result
Result:
Vertebral Arteries post PTA
•Dye: 150 ml Ultravist
•Fluoroscopy time: 16 min.
•Procedure time: 1h:15min.
•No complication; Hospital stay: 2 days
Express 2.5x8
Novel approche:
Express 3.5x8
Guiding catheter Left Judkins 4, 6F (Launcher)
in right and left subclavian artery for stent delivery
to left and right VA.
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.