Author + information
- Received March 8, 2016
- Accepted March 11, 2016
- Published online July 11, 2016.
- Menno van Gameren, MD, PhD∗ (, )
- Jurgen M.R. Ligthart, RT,
- Tjebbe W. Galema, MD, PhD,
- Koen Nieman, MD, PhD and
- Nicolas M. Van Mieghem, MD, PhD
- Department of Cardiology, Thoraxcenter, Erasmus University Medical Center, Rotterdam, the Netherlands
- ↵∗Reprint requests and correspondence:
Dr. Menno van Gameren, Department of Cardiology, Erasmus University Medical Center, Room BA-316, P.O. Box 2040, 3000 CA Rotterdam, the Netherlands.
A 31-year-old woman with a history of chemotherapy and mediastinal radiation therapy for Hodgkin’s lymphoma presented with stable angina followed by a positive stress test.
A coronary computed tomography scan revealed a high-grade ostial right coronary artery stenosis without calcium (Agatston score zero) (Figure 1A). Invasive coronary angiography confirmed a focal tight ostial lesion with no further lesions or signs of atherosclerosis (Figures 1B and 1C). Lesion characterization by intravascular ultrasound and optical coherence tomography identified an eccentric fibrous and fibrofatty plaque (Figures 1D and 1E) with extraordinary constrictive remodeling (Figure 2). The patient was successfully treated with a drug-eluting stent.
The presence of fibrous and fibrofatty plaques and lack of calcium has been described previously in patients that had undergone radiation therapy for Hodgkin’s lymphoma (1–4). The constrictive remodeling revealed by intravascular ultrasound analysis in our patient provides further insights into the distinct pattern of radiation induced coronary plaque formation in comparison to typical atherosclerotic coronary artery disease.
Dr. Nieman has received institutional research support from Siemens, GE, Bayer, and Heartflow. All other authors have reported that they have no relationships relevant to the contents of this paper to disclose.
- Received March 8, 2016.
- Accepted March 11, 2016.
- American College of Cardiology Foundation
- Dunsmore L.D.,
- LoPonte M.A.,
- Dunsmore R.A.