DOI: https://doi.org/10.36347/sjmcr.2026.v14i06.013

Pages: 1379-1384

Thoracic radiotherapy is an essential therapeutic modality in the management of breast cancer, particularly in locally advanced disease or following breast-conserving surgery. However, it is associated with potentially severe, often delayed cardiovascular complications. These conditions, frequently asymptomatic, are currently the leading non-malignant cause of death among cancer survivors treated with radiotherapy. Among late complications, radiation-induced coronary artery disease [RICAD] is the most concerning. We report the case of a 63-year-old woman with no significant cardiovascular risk factors, previously treated for left breast cancer with surgery, chemotherapy, and left-sided thoracic radiotherapy. A complete cardiological evaluation was performed following the onset of late chest pain. Echocardiography revealed segmental hypokinesia with reduced left ventricular ejection fraction. Coronary angiography demonstrated a severe ostial stenosis of the left anterior descending artery [LAD], without diffuse disease or calcification. Percutaneous coronary intervention with drug-eluting stent resulted in a favorable outcome, with partial recovery of ventricular function at 6 months. This case illustrates a severe and characteristic complication of left breast cancer treatment, likely secondary to radiation-induced fibrosing endarteritis. Diagnosis relies on lesion topography and the absence of classical atherosclerotic risk factors. Ostial LAD involvement should be suspected in any late ischemia in previously irradiated patients, even in the absence of conventional risk factors. Advances in radiotherapy techniques have reduced this risk, but long-term cardio-oncological follow-up remains essential.