Hong Cheng, Zhou Daibing, Chen Haiming, Wu Xiaofeng, Guo Wenliang, Cui Jiangyu, Guan Weijie, Zhong Nanshan, Lin Jielong
National Clinical Research Center for Respiratory Disease, Guangzhou Institute of Respiratory Health, State Key Laboratory of Respiratory Disease First Affiliated Hospital of Guangzhou Medical University Guangzhou China.
Department of Pulmonary and Critical Care Medicine Huashan Hospital, Fudan University Shanghai China.
Pulm Circ. 2025 Apr 29;15(2):e70076. doi: 10.1002/pul2.70076. eCollection 2025 Apr.
Fibrosing mediastinitis (FM) can block pulmonary vessels and airways, hindering treatment efficacy. Pulmonary artery (PA) stenting might provide a solution in such cases. This study involved 30 patients who had 49 PA stenting procedures for FM. Data on baseline characteristics, CT pulmonary angiography images, stent patency, and hemodynamics were collected. Patients with FM often had a history of chronic obstructive pulmonary disease (15/30), tuberculosis (12/30), and pneumoconiosis (11/30). Patients exhibited typical symptoms such as dyspnea, exercise intolerance, and cough. FM appeared as multiple bilateral shadows with enlarged hilar and mediastinal lymph nodes. Our study found that the PA involvement alone was predominantly in the left and right lower basilar trunk, with the left lower pulmonary arteries (LLPA) involved in 80% of cases and the right lower pulmonary arteries (RLPA) in 100%. Moreover, over 2/3 of patients showed involvement of both PA and pulmonary vein (PV), mainly in the bilateral upper lung lobes, then in the right middle lobe and left lingual lobe. After PA stent implantation, patients showed enhanced tricuspid annular plane systolic excursion (20.6 vs. 18.5, < 0.001) and reduced right atrial diameter (35.5 vs. 37.3, = 0.042), along with significant gains in 6-min walk distance (465.2 vs. 392.7, = 0.002) and improved World Health Organization functional class ( < 0.001). Hemodynamic parameters improved after PA stent placement with significant reductions in systolic pulmonary artery pressure (PAP) (51.1 vs. 64.2, < 0.001), mean PAP (28.4 vs. 35.2, < 0.001), pulmonary vascular resistance (4.7 vs. 5.9, = 0.004), and stent gradient (11.2 vs. 33.4, < 0.001), along with increased patency (84.8% vs. 28%, < 0.001), and fractional flow reserve (0.84 vs. 0.44, < 0.001). Over a median follow-up of 331 days (range 45-980), no significant stent stenosis occurred ( = 0.287). Mild adverse events like cough and mild hemoptysis were noted during the procedure. Secondary intervention was needed for 5 of 49 stents. PA stents placement, especially the LLPA and RLPA, improved pulmonary vascular patency, hemodynamics, and symptoms.
纤维性纵隔炎（FM）可阻塞肺血管和气道，影响治疗效果。肺动脉（PA）支架置入术可能为这类病例提供解决方案。本研究纳入了30例因FM接受49次PA支架置入术的患者。收集了患者的基线特征、CT肺血管造影图像、支架通畅情况及血流动力学数据。FM患者常有慢性阻塞性肺疾病史（15/30）、结核病史（12/30）和尘肺病史（11/30）。患者表现出呼吸困难、运动不耐受和咳嗽等典型症状。FM表现为双侧多发阴影，肺门和纵隔淋巴结肿大。我们的研究发现，单纯PA受累主要位于左右下基底干，80%的病例累及左下肺动脉（LLPA），100%累及右下肺动脉（RLPA）。此外，超过2/3的患者PA和肺静脉（PV）均受累，主要累及双侧上肺叶，其次为右中叶和左舌叶。PA支架植入后，患者三尖瓣环平面收缩期位移增加（20.6对18.5，<0.001），右心房直径减小（35.5对37.3，=0.042），6分钟步行距离显著增加（465.2对392.7，=0.002），世界卫生组织功能分级改善（<0.001）。PA支架置入后血流动力学参数改善，收缩期肺动脉压（PAP）显著降低（51.1对64.2，<0.001），平均PAP降低（28.4对35.2，<0.001），肺血管阻力降低（4.7对5.9，=0.004），支架压差降低（11.2对33.4，<0.001），通畅率增加（84.8%对28%，<0.001），血流储备分数增加（0.84对0.44，<0.001）。中位随访331天（范围45 - 980天），未发生明显的支架狭窄（=0.287）。术中记录到咳嗽和轻度咯血等轻度不良事件。49个支架中有5个需要二次干预。PA支架置入，尤其是LLPA和RLPA支架置入，可改善肺血管通畅情况、血流动力学及症状。
