Extrinsic compression of coronary and pulmonary vasculature

Abstract

Coronary artery disease from atherosclerosis induced stenosis remains the leading cause of acute coronary syndrome (ACS) and death worldwide, however extrinsic compression of coronary arteries from adjacent anatomical and pathological structures is an infrequent but important diagnosis to be aware of, especially given the nonspecific symptoms of chest pain that mimic angina in patients with pulmonary hypertension (PHT) and congenital heart disease. Non-invasive CT angiography is an invaluable diagnostic tool for detection of coronary artery compression, pulmonary artery dilatation and pulmonary vascular compression. Although established guidelines are not available for management of left main coronary artery (LMCA) compression syndrome, percutaneous coronary intervention and stent implantation remain a feasible option for the treatment, specifically for patients with a high surgical risk. Treatment of pulmonary vein or artery compression is more varied and determined by etiology. This review article is focused on detailed discussion of extrinsic compression of coronary arteries, mainly the LMCA and brief discussion on pulmonary vasculature compression by surrounding anatomical and pathological entities, with focus on pathophysiology, clinical features, complications and role of imaging in its diagnosis and management.

Acute coronary syndrome due to extrinsic left main compression

“…Some authors suggest that coronary artery bypass grafting should be performed [3]. However, surgical treatment is associated with the high risk of mortality in severe PAH patients, and our patients had previously rejected the proposed surgical treatment of ASD [4]. There have been several reports of successful percutaneous coronary intervention (PCI) with either bare-metal stents (BMS) or drug-eluting stents in LM compression, showing comparable results regardless of stent type up to 3 years [2,5].…”

Potential Value of FAPI PET/CT in the Detection and Treatment of Fibrosing Mediastinitis: Preclinical and Pilot Clinical Investigation

“…In recent years, stenting from within the pulmonary artery to resolve stenosis due to fibrous tissue constriction is the main clinical treatment, which has significantly improved modality and prognosis of PH-FM. , However, it is expensive and has been found to not be ideal for extensive lesions due to the limited length of the stent. Surgical debridement of fibrous tissues for causative treatment is very risky because most FM occurs in the mediastinum, where large vessels such as the aorta and pulmonary arteries are involved. , Our study proposes a new non-invasive therapeutic strategy, radiotargeted therapy, for the etiology of PH-FM, either alone or in combination with stenting from within the pulmonary artery and includes a series of preclinical evaluations of safety and efficacy.…”

“…Therefore, subcutaneous modeling was chosen for this study because of the small amount of adipose tissue and the flatness of the posterior neck, which facilitates non-invasive assessment of the treatment effect, such as measurement of the fibrotic lesion size and determination of In recent years, stenting from within the pulmonary artery to resolve stenosis due to fibrous tissue constriction is the main clinical treatment, which has significantly improved modality and prognosis of PH-FM. 45,46 However, it is expensive and has been found to not be ideal for extensive lesions due to the limited length of the stent. Surgical debridement of fibrous tissues for causative treatment is very risky because most FM occurs in the mediastinum, where large vessels such as the aorta and pulmonary arteries are involved.…”

Acquired Extrinsic Pulmonary Stenosis Secondary to a Compressing Mediastinal Tumor

“…This diagnosis can be verified, and the degree of obstruction can be determined, using right cardiac catheterization with pulmonary angiography. CT and MRI are less invasive yet nonetheless effective diagnostic tools [11].…”