Bifurcation Stenting Using Bioresorbable Vascular Scaffold in an Adult Male With Radiation-Induced Coronary Artery Disease and Hodgkin Lymphoma: A Case Report

Abstract

INTRODUCTION: Radiation-induced coronary artery disease is associated with absolute risk between 0.1% and 0.5% per year after mediastinal radiotherapy of Hodgkin disease. Risk increases with time and becomes statistically significant after 10 years. This often involves the left anterior descending (LAD) and right coronary arteries with proximal arterial narrowing involving the coronary ostia. This is the first documented case of radiation-induced coronary artery disease in a 25-year-old Filipino man diagnosed with nodular sclerosing-type Hodgkin lymphoma stage IIA treated with percutaneous revascularization using bioresorbable vascular scaffolds in a bifurcation type of lesion admitted at St Luke’s Medical Center for chest pain. Patient reported progressive worsening of exertional angina 16 months after chemotherapy and external beam radiation therapy in the neck and mediastinum. Treadmill exercise test revealed inducible ischemia in the inferior leads at stage 3, 7 metabolic equivalents. Coronary angiogram showed severe stenosis involving the midsegment of the proximal LAD artery and the ostial-to-proximal segment of the first diagonal branch, a bifurcation lesion, Medina 1,1,1. A percutaneous coronary intervention was successfully done using two bioresorbable vascular scaffolds via T-and-protrude bifurcation stenting technique and achieves a brisk TIMI (Thrombolysis In Myocardial Infarction) 3 flow. Follow-up after 6 months showed a normal treadmill exercise test. However, patient still complains of occasional chest pain and epigastric discomfort. Coronary angiogram was repeated demonstrating an 80% stenosis in the proximal LAD without evidence of in-stent stenosis. This was confirmed by optical coherence tomography with adequate stent apposition to the intima with a note of a large chronic red thrombus proximal to the previously deployed stent; thus, percutaneous coronary intervention using drug-eluting stent was performed. KEYWORDS: radiation-induced coronary artery disease, Hodgkin lymphoma, bifurcation stenting, bioresorbable vascular scaffold, optical coherence tomography