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[Radiation-induced coronary ostial stenosis, a case of redo coronary bypass for the restenosis following patch angioplasty].

The patient was a 45-year-old woman who had had a tumor resection for thymic carcinoid and subsequent mediastinal irradiation (50 Gy) 3 years before the onset of angina pectoris during exercise. Coronary angiography (CAG) revealed an isolated ostial stenosis of the left main coronary trunk (LMT). Angiography also showed an occluded right internal thoracic artery (ITA) at its origin. The patient underwent patch angioplasty of the LMT orifice using a piece of the saphenous vein graft (SVG). One month after the operation, CAG revealed a success of operation with an enlarged LMT orifice and she was discharged. However, 3 months after the operation, angina pectoris recurred and a repeated CAG showed a 90% stenosis of the LMT at the place 1 cm distal to the orifice. Emergency CABG (the left ITA to the LAD and the SVG to the LCX) was accomplished with disappearance of angina. Post-CABG angiography revealed patent left ITA and SVG in association with complete obstruction of the LMT. One year after the second operation, she was free from symptoms. This case as well as other reports concerning radiation-induced coronary stenosis suggest that patch angioplasty for this specific lesions may have a high incidence of stenosis recurrence. Coronary bypass grafting that can be performed at the place away from the active proliferative lesion may be a better selection.