Primary percutaneous coronary intervention and intravascular ultrasound imaging for coronary thrombosis after cisplatin-based chemotherapy

• Published in: Heart and vessels 2012-11, Vol.27 (6), p.634-638
• Main Authors: Ito, Daisuke, Shiraishi, Jun, Nakamura, Takeshi, Maruyama, Naoki, Iwamura, Yumi, Hashimoto, Sho, Kimura, Masayoshi, Matsui, Akihiro, Yokoi, Hirokazu, Arihara, Masayasu, Irie, Hidekazu, Hyogo, Masayuki, Shima, Takatomo, Kohno, Yoshio, Matsumuro, Akiyoshi, Sawada, Takahisa, Matsubara, Hiroaki
• Format: Article
• Language: English
• Subjects: Adult; Angiography; Antineoplastic Combined Chemotherapy Protocols - adverse effects; Biomedical Engineering and Bioengineering; Cardiac Surgery; Cardiology; Case Report; Chemotherapy; Cisplatin - adverse effects; Coronary Angiography; Coronary Thrombosis - chemically induced; Coronary Thrombosis - diagnostic imaging; Coronary Thrombosis - therapy; Gastrointestinal diseases; Humans; Lung cancer; Lung Neoplasms - drug therapy; Male; Medical imaging; Medicine; Medicine & Public Health; Middle Aged; Myocardial Infarction - chemically induced; Myocardial Infarction - diagnostic imaging; Myocardial Infarction - therapy; Percutaneous Coronary Intervention; Predictive Value of Tests; Stomach Neoplasms - drug therapy; Thrombectomy; Thrombosis; Treatment Outcome; Ultrasonography, Interventional; Vascular Surgery
• ISSN: 0910-8327; 1615-2573
• DOI: 10.1007/s00380-011-0222-5

Although cisplatin is indispensable for the chemotherapy treatment of many malignancies, cisplatin-associated thrombosis is attracting increasing attention. However, experience of primary percutaneous coronary intervention (PCI) and intravascular ultrasound imaging (IVUS) for coronary thrombosis, possibly due to cisplatin-based chemotherapy, has been limited. Case 1 with postoperative gastric cancer developed acute myocardial infarction (AMI) on the sixth day of the second chemotherapy course with conventional doses of cisplatin and tegafur gimeracil oteracil potassium. Emergency coronary angiography (CAG) showed a filling defect in the proximal left anterior descending coronary artery (LAD) concomitant with no reflow in the distal LAD. Case 2 with advanced lung cancer and brain metastasis suffered AMI on the fifth day of the first chemotherapy course with conventional doses of cisplatin and gemcitabine. Emergency CAG delineated a total occlusion in the proximal right coronary artery. In both cases, thrombectomy using aspiration catheter alone obtained optimal angiographic results and subsequent IVUS revealed no definite atherosclerotic plaque, while slow flow still remained even after selective intra-coronary infusion of vasodilator in the case 1. These cases suggest that primary PCI using thrombus-aspiration catheter might be safe and effective for coronary thrombosis due to cisplatin-based chemotherapy.