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Endovascular stent implantation for extrinsic pulmonary arterial stenosis (PAS) in adults is anecdotal.
We systematically reviewed etiology, clinical characteristics, safety and outcomes of the published cases of extrinsic PAS treated with endovascular approach.
A total of 113 published cases of extrinsic PAS were reviewed. The most common etiology of extrinsic PAS was mediastinal mass (31%), primary tumors of pulmonary artery (27%), fibrosing mediastinitis (18%), pulmonary pseudoaneurysm (17%), anastomotic stenosis post lung transplantation (7%) and radiation induced pulmonary stenosis (1%). Mean age at presentation was 52 years ± 14.75 with a M:F ratio of 1:1. Dyspnea (41%) was the most common presenting symptom followed by chest pain (29%), hemoptysis (11%), cough (11%), peripheral edema (7.4%), right heart failure (6%) and pulmonary hypertension (3%). Right Pulmonary artery was involved in 40%, bilateral pulmonary artery in 35% and left pulmonary artery in 15% of cases. 41(36%) cases reported stent implantation with Palmaz, Wall stent and stent grafts being commonly used stents. In all cases endovascular treatment was associated with symptom improvement along with reduction in trans-lesional gradient. 6 (15%) cases reported immediate complications after stent implantation. In 7 (17%) cases in-stent restenosis was reported at 6 months follow-up. There was no immediate peri-procedural mortality.
Stent implantation is an effective and safe alternative option for the treatment of extrinsic PAS.