Percutaneous Coronary Intervention for Left Main Compression Syndrome due to Severe Idiopathic Pulmonary Arterial Hypertension: One Year Follow-up Using Intravascular Imaging

Abstract

A 60-year-old woman presented with ST-elevation myocardial infarction due to extrinsic compression of the left main coronary artery (LMCA) caused by a dilated pulmonary artery (PA) with idiopathic pulmonary hypertension and was successfully treated with intravascular ultrasound-and optical coherence tomographyguided stenting. Continuous subcutaneous epoprostenol infusion therapy was initiated immediately after the procedure and increased aggressively. Imaging modalities were extremely useful in making the diagnosis and providing follow-up of LMCA compression syndrome in this case. Over the one-year observation period, a sufficient hemodynamic improvement was obtained, without exacerbation of the PA dilatation, resulting in the absence of compression of the LMCA.

Left main coronary artery compression due to pulmonary artery aneurysm: Three-year clinical and angiographic follow-up after stenting

“…[7] Since then, other authors reported angiographic and clinical followup success, confirming favorable outcomes in such cases with the technique. [8][9][10][11][12][13][14] In all reported cases, as well as in the present report, the stenosis in LMCA was not followed by obstructive disease in other coronary territories. The absence of atherosclerotic coronary disease is a sign for suspicion of extrinsic LMCA compression, although aortic diseases, such as systemic vas-culitis, syphilitic aortitis or rheumatologic diseases, shall be excluded.…”

“…Most reports of similar cases present up to 12-month clinical follow-up. [5,6,14] In today's clinical and interventional practice, LMCA PCI is feasible and has been proven safe, especially in situations of elevated clinical risk and/or favorable angiographic characteristics and low anatomic complexity.…”

Rapid progression of pulmonary artery dilatation in pulmonary hypertension

“…Aorto-coronary bypass and unprotected LMCA stent implantation are the only currently strategies. Given the high surgical mortality in patients with PAH, LMCA stenting has been favored as the revascularization strategy of choice, and several authors have reported successful results in this kind of patients [7].…”

Compresión del tronco de la arteria coronaria izquierda por la arteria pulmonar dilatada

“…Si bien es la escasa bibliografía disponible y apoyándose en una larga experiencia en intervencionismo coronario acumulado, se considera como mejor alternativa intervenir a estos pacientes sintomáticos implantando un stent en el TCI (7,8) . Aunque, tal como ocurrió en este caso, la revascularización con stent puede mejorar la sintomatología de la angina, no existe mucha información sobre el beneficio a largo plazo (9) .…”