Batra Kiran, Saboo Sachin S, Kandathil Asha, Canan Arzu, Hedgire Sandeep S, Chamarthy Murthy R, Kalva Sanjeeva P, Abbara Suhny
Department of Radiology, University of Texas Southwestern Medical Center, Dallas, TX, USA.
Division of Cardiothoracic Imaging, Department of Radiology, University of Texas Health Science Center, TX, USA.
Cardiovasc Diagn Ther. 2021 Oct;11(5):1125-1139. doi: 10.21037/cdt-20-155.
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.
动脉粥样硬化所致狭窄引起的冠状动脉疾病仍是全球急性冠状动脉综合征（ACS）和死亡的主要原因，然而，相邻解剖和病理结构对冠状动脉的外在压迫是一种罕见但重要的需警惕的诊断，特别是考虑到患有肺动脉高压（PHT）和先天性心脏病的患者中，胸痛等非特异性症状可类似心绞痛。无创CT血管造影是检测冠状动脉压迫、肺动脉扩张和肺血管压迫的宝贵诊断工具。虽然目前尚无关于左主干冠状动脉（LMCA）压迫综合征管理的既定指南，但经皮冠状动脉介入治疗和支架植入仍是一种可行的治疗选择，特别是对于手术风险高的患者。肺静脉或动脉压迫的治疗则更为多样，取决于病因。本文综述重点详细讨论冠状动脉的外在压迫，主要是左主干冠状动脉，并简要讨论周围解剖和病理实体对肺血管的压迫，重点关注病理生理学、临床特征、并发症以及影像学在其诊断和管理中的作用。
