Distinct Pattern of Constrictive Remodeling in Radiotherapy-Induced Coronary Artery Disease

Gameren, Menno van; Ligthart, Jürgen; Galema, Tjebbe W.; Nieman, Koen; Mieghem, Nicolás M. Van

doi:10.1016/j.jcin.2016.03.012

Cited by 5 publications

(6 citation statements)

References 4 publications

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“…Our OCT findings, in accordance with previously reported cases [4,5], confirm the hypothesis that RT-CAD is characterized by a specific lesion pattern consisting simultaneously of coronary tunica intima fibrosis and premature atherosclerosis. Because of the presence of fibrous tissue not completely related to lipid accumulation, which often shows a progressive and constrictive pattern, OCT might play an important role in optimizing lesion treatment, especially in terms of choosing appropriate stent properties.…”

Section: Discussionsupporting

confidence: 92%

OCT findings of radiotherapy-induced coronary artery disease: A “two-hit combined hypothesis”

Buono

Sulženko

Kočka

et al. 2020

Journal of Cardiology Cases

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Section: Discussionsupporting

confidence: 92%

OCT findings of radiotherapy-induced coronary artery disease: A “two-hit combined hypothesis”

Buono

Sulženko

Kočka

et al. 2020

Journal of Cardiology Cases

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“…Even in the high-fat diet hyperlipidemic apolipoprotein E knockout mice model, prominent fibrosis with a smaller lipid core was observed [6] . This was consistent with the IVUS findings in our case and the literature [7,8] . Atherosclerotic lesions, especially advanced lesions, are characterized by a necrotic core with a large lipid pool, which can be unstable even before becoming obstructive.…”

Section: Discussionsupporting

confidence: 91%

“…[ 6 ] This was consistent with the IVUS findings in our case and the literature. [ 7 , 8 ] Atherosclerotic lesions, especially advanced lesions, are characterized by a necrotic core with a large lipid pool, which can be unstable even before becoming obstructive. Thus, thrombotic complications due to plaque rupture or plaque erosion often bring patients to the clinician with the most dramatic presentations, such as acute coronary syndrome.…”

Section: Discussionmentioning

confidence: 99%

Radiotherapy-induced isolated left main coronary artery disease presenting with cardiogenic shock

Liu

Lou

et al. 2022

Medicine

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Rationale:Mediastinal radiotherapy is a common practice for treating breast cancer and Hodgkin's lymphoma. Radiotherapy causes cardiovascular damage and has attracted increasing attention, particularly among Hodgkin's lymphoma patients, as they receive a higher dose of radiation.Patient concerns:A 36-year-old woman with a past medical history of Hodgkin's lymphoma presented with persistent chest pain for 3 hours. She experienced exertional chest pain 1 month before when she was climbing stairs, which disappeared after a few minutes with rest, but recurred with a similar level of exertion. Three hours before admission to the emergency room, the chest pain persisted and was accompanied by diaphoresis and dyspnea.Diagnosis:Cardiogenic shock caused by radiotherapy-induced left main coronary artery disease.Interventions:Urgent angiography revealed left main coronary artery stenosis. Intravascular ultrasonography showed diffuse fibrous proliferation in the left main coronary artery. Hemodynamic instability was resolved after drug-eluting stent implantation.Outcomes:The patient was discharged uneventfully 5 days after the procedure, with a prescription for dual antiplatelet and statin therapy. She was asymptomatic with good exercise tolerance at the 3-month follow-up.Conclusion:Radiotherapy-induced isolated left main coronary artery disease is a rare complication of cancer radiotherapy and can occur years or decades after treatment. Fibrous proliferation is a characteristic pathologic change in the exposed coronary arteries.

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“…Case reports have also suggested early onset of negative remodelling, but this has not been confirmed in larger series. 20…”

Section: Pathology and Pathophysiologymentioning

confidence: 99%

How to prevent and manage radiation-induced coronary artery disease

Cuomo

Javaheri

Sharma

et al. 2018

Heart

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Radiation-induced coronary heart disease (RICHD) is the second most common cause of morbidity and mortality in patients treated with radiotherapy for breast cancer, Hodgkin's lymphoma and other prevalent mediastinal malignancies. The risk of RICHD increases with radiation dose. Exposed patients may present decades after treatment with manifestations ranging from asymptomatic myocardial perfusion defects to ostial, triple-vessel disease and sudden cardiac death. RICHD is insidious, with a long latency and a tendency to remain silent late into the disease course. Vessel involvement is often diffuse and is preferentially proximal. The pathophysiology is similar to that of accelerated atherosclerosis, characterised by the formation of inflammatory plaque with high collagen and fibrin content. The presence of conventional risk factors potentiates RICHD, and aggressive risk factor management should ideally be initiated prior to radiation therapy. Stress echocardiography is more sensitive and specific than myocardial perfusion imaging in the detection of RICHD, and CT coronary angiography shows promise in risk stratification. Coronary artery bypass grafting is associated with higher risks of graft failure, perioperative complications and all-cause mortality in patients with RICHD. In most cases, the use of drug-eluting stents is preferable to surgical intervention, bare metal stenting or balloon-angioplasty alone.

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Distinct Pattern of Constrictive Remodeling in Radiotherapy-Induced Coronary Artery Disease

Cited by 5 publications

References 4 publications

OCT findings of radiotherapy-induced coronary artery disease: A “two-hit combined hypothesis”

OCT findings of radiotherapy-induced coronary artery disease: A “two-hit combined hypothesis”

Radiotherapy-induced isolated left main coronary artery disease presenting with cardiogenic shock

How to prevent and manage radiation-induced coronary artery disease

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