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Left internal thoracic artery graft occlusion following mediastinal radiation therapy
H E Schulman1, K S Korr, T J Myers
1Miriam Hospital, Brown University, Providence, RI 02906.
Insights
Mediastinal radiation therapy can lead to premature coronary artery disease. Internal thoracic artery grafts may have reduced long-term patency in these patients, suggesting saphenous vein grafts as a potential alternative.
Area of Science:
- Cardiology
- Oncology
- Radiation Oncology
Background:
- Mediastinal radiation therapy (MRT) is a known risk factor for late-onset cardiovascular complications, including premature coronary artery disease (CAD).
- Coronary artery bypass grafting (CABG) is a common treatment for severe CAD, with internal thoracic artery (ITA) grafts typically offering excellent long-term patency.
Observation:
- A 51-year-old male, previously treated with MRT for a posterior mediastinal tumor 18 years prior, presented with severe multivessel CAD requiring CABG.
- The patient experienced recurrent angina one year post-CABG due to the apparent occlusion of his left internal thoracic artery (LITA) graft.
Findings:
- The occlusion of the LITA graft is suspected to be a consequence of radiation-induced injury to the vessel during prior MRT.
- This case suggests that ITA grafts may not achieve the same long-term patency in patients with a history of MRT compared to the general population.
Implications:
- Patients with a history of MRT undergoing CABG may have a higher risk of ITA graft failure.
- Saphenous vein grafts (SVGs) might be a more reliable alternative for CABG in this specific patient population.
- Further research is warranted to investigate the long-term outcomes of different graft types in patients with prior MRT.
Abstract:
Premature coronary artery disease is a late consequence of mediastinal radiation therapy. Many of these patients have been successfully treated with coronary bypass surgery. A 51-year-old man underwent bypass surgery for severe multivessel coronary disease 18 years following radiation therapy for a posterior mediastinal tumor. Recurrent angina 1 year later occurred following closure of the left internal thoracic artery graft. We suspect that this occurred as a consequence of injury sustained during mediastinal irradiation. Patients who have undergone prior mediastinal radiation therapy may not be assured the excellent long-term patency of the internal thoracic artery graft which has been reported for the general population. Saphenous vein grafts probably should be considered instead.