A. Joseph et al., DIRECTIONAL CORONARY ATHERECTOMY FOR THE DIAGNOSIS AND TREATMENT OF RADIATION-INDUCED CORONARY-ARTERY STENOSIS, Journal of interventional cardiology, 8(4), 1995, pp. 355-358
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.