C82 PROCEDURES AND DEVICES FOR CALCIUM TREATMENT IN AN INCREASINGLY COMMON SCENARIO: YOUNG ONCOLOGIC PATIENTS

Abstract

Abstract Background Cardiovascular disease and cancer have a high prevalence in Western countries, sharing many risk factors: obesity, diabetes, cigarette smoking, advanced age, diet and sedentary lifestyle. There is growing evidence that patients with ischemic heart disease (CAD) have a higher risk of developing cancer and, conversely, patients with a history of cancer are exposed to a higher incidence of CAD. In particular, cancer and its related therapies may promote the process of atherosclerosis, often with high calcific burden. Case Report This is a case of a 58 years old gentleman with a past smoking habit. Unfortunately from 2019 he was diagnosed by a stage IV lung adenocarcinoma, actually in 3rd line therapy: Carboplatin–Alimta, Atezolizumab and Paclitaxel weekly; no metastatic localizations was found at follow up CT scan. Last July, the patient complained of breath fatigue during exertion. At a complete cardiologic examination EKG was normal, and severe aortic stenosis was detected with concentric left ventricular hypertrophy, preserved ejection fraction. At CT scan, the aortic valve was confirmed as bicuspid Sievers type 0 (Figure 1, panel A). Vmax was 5.49 cm/s, max gradient was up to 120 mmHg, and medium gradient was 67 mmHg, as shown in Figure 1, panel B. Coronary angiography showed a very severe, focal, concentric calcific lesion of the left anterior descendant branch (Figure 2, Panel A). The patient was then referred to our local Heart Team and due to his oncological condition with prognosis >12 months, we decided to treat him percoutaneously. Aortic stenosis was treated Transcatheter Aortic Valve Implantation (TAVI) a few days later: predilatation, implant of a with a balloon–expandable valve Edwards Sapien 3 n°23 and post–dilatation, by femoral access (Figure 2, four steps of TAVI). Coronary lesion was uncrossable with the lowest profile balloons, so rotatripsy was perfomed: rotational atherectomy followed by 40 pulses of lithotripsy with Shockwave (Figure 2, Panel B and C). Everolimus eluting stent 3.00 x 23 mm was implanted and optimized (Figure 2, Panel D). Conclusion Recent devices and techniques in Invasive Cardiology allow percutaneous therapies for patients with time–dependent diseases, such as patients with advanced lung adenocarcinoma. Lately, oncological therapies for this type of lung cancer are very promising, allowing the combination of interventional procedures capable of further increasing the prognosis of these patients.