DIRECTIONAL CORONARY ATHERECTOMY FOR THE DIAGNOSIS AND TREATMENT OF RADIATION-INDUCED CORONARY-ARTERY STENOSIS

While radiation therapy has been known to cause myocardial and pericar dial damage, its role in accentuating coronary artery disease in the a bsence of traditional cardiovascular risk factors has been controversi al. As younger patients with treatable cancers are being treated with mediastinal radiation, coronary artery disease as a cause for severe c hest pain should be enter-rained as a possible diagnosis. We describe a 25-year-old male who presented with an inferior wall myocardial infa rction 6 years after receiving mediastinal radiation and chemotherapy for Hodgkin's disease. He was subsequently treated by directional athe rectomy to a 95% lesion in the right coronary artery. Histological exa mination of the atherectomy specimen revealed evidence of radiation-in duced endothelial damage that had resulted in plaque formation and sub sequent ischemia. Possible mechanisms for radiation-induced coronary a rtery disease and treatment options are discussed.