OCT findings of radiotherapy-induced coronary artery disease: A "two-hit combined hypothesis".

Radiotherapy-induced coronary artery disease (RT-CAD) is a well-known late complication of anti-neoplastic treatment. Although definitive diagnosis requires standard coronary angiography, modern intracoronary imaging techniques, such as optical coherence tomography (OCT), are able to provide detailed morphological characteristics of RT-CAD lesions. We report the case of a 42-year-old male with a previous history of treated Hodgkin's lymphoma who complained of typical chest pain on minimal exertion. Coronary angiography showed significant 2-vessel disease. Use of OCT documented the fibro-fatty nature of coronary lesions, showing a constrictive pattern, compatible with RT-CAD. The patient underwent successful revascularization of both lesions. <Learning objective: Radiotherapy-induced coronary artery disease is a possible complication of anti-neoplastic treatment, characterized by premature atherosclerosis and vessel fibrosis. Optical coherence tomography is a modern tool able to characterize coronary lesions and to provide useful information concerning treatment strategy, including stent size choice.>.