Proof is in the paclitaxel: Catheter directed intracoronary paclitaxel as salvage therapy for refractory cardiac allograft vasculopathy
Shah R, Nasr Y, Raymond T, Khandelwal A, Tita C. Proof is in the paclitaxel: Catheter directed intracoronary paclitaxel as salvage therapy for refractory cardiac allograft vasculopathy. J Am Coll Cardiol. Mar 2017;69(11):2462-2462.
J Am Coll Cardiol
Background: Advances in therapy have improved outcomes in cardiac transplantation however allograft vasculopathy (AV) continues to limit long-term success. Treatment options for AV include re-transplant, or percutaneous coronary intervention (PCI) however efficacy remains unproven and recurrence is common. Case: A 45-year-old female was evaluated for progressive, disabling angina. She had history of diabetes, hyperlipidemia, and orthotopic heart transplant (OHT) at age 34 for non-ischemic cardiomyopathy, complicated by transplant rejection and AV leading to second OHT at age 40. At 24 months post-transplant (MPT) she underwent left heart catheterization (LHC) revealing 90% stenosis of the ostial left anterior descending artery (LAD). Her anatomy was deemed ineligible for bypass and she declined a third transplant. Decision-Making: From 29 to 50 MPT she underwent three separate PCI to theostial LAD, each followed by recurrence of severe (>90%) stenosis and symptoms. Based on the drug's anti-proliferative properties, a strategy of intracoronary Paclitaxel was offered with theintention of preventing AV. At 50 MPT she underwent repeat PCI involving balloon angioplasty and catheterbased delivery of 595mcg of Paclitaxel directed at theostial LAD lesion. She is now 38-months post Paclitaxel therapy (88 MPT) without recurrence of ostial LAD restenosis. Conclusions: This case represents the distinct potential for catheter directedintracoronary Paclitaxel as possible therapy forrefractory AV.