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

2. 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.

3. 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. 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.

4. Description of the problem Coronary and peripheral artery angiography: LCA Left SCA Left VA Right VA Right SCA 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

5. 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

6. Result: LCA after PCI LCA RAO 30: final result Kissing postdilatation: LM/LAD 3.5x20 LM/Cx 3.25x20mm 14 atm, 20 sec.

7. 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 2.5x8Express 3.5x8 Dye: 150 ml Ultravist Procedure time: 1h:15min. Fluoroscopy time: 16 min. No complication; Hospital stay: 2 days Novel approche:

8. 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.