Late-Late Occlusion After Intracoronary Brachytherapy
A 57-year-old man with a history of anterior myocardial infarction in April 1997, initially treated with successful thrombolysis, underwent cardiac catheterization due to persistent postinfarction angina. A single-vessel disease, with a significant lesion in the left anterior descending coronary artery (LAD), was found. The patient was treated with balloon angioplasty followed by intracoronary beta radiation therapy according to the Beta Energy Restenosis Trial (BERT). He received 16 Gy at 2 mm from the centerline of the 90Sr/90Y source. He remained asymptomatic for 41/2 years. During this period, he underwent control angiography with the use of Intravascular Ultrasound (IVUS) at 6 months and 3 years, as mandated by protocol. After this period, he again developed angina, and an exercise test was positive for ischemia. Diagnostic coronary angiogram at almost 5 years revealed single-vessel disease, with totally occluded LAD with collateral filling from the right coronary artery. The angiographic sequence is presented in Figure 1. The IVUS images are presented in Figure 2. Before the reintervention, a 16-row, electrocardiographic-gated, cardiac, multislice spiral CT scan was also performed (Figure 3). An attempt at percutaneous recanalization was not successful, and the patient underwent coronary artery bypass surgery with implantation of the left internal mammary artery in the LAD.
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