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Pulmonary Artery Stent Implantation for Fibrosing Mediastinitis: Our Clinical Experience
Cheng Hong1, Daibing Zhou2, Haiming Chen1
1National 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.
Abstract:
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, p < 0.001) and reduced right atrial diameter (35.5 vs. 37.3, p = 0.042), along with significant gains in 6-min walk distance (465.2 vs. 392.7, p = 0.002) and improved World Health Organization functional class (p < 0.001). Hemodynamic parameters improved after PA stent placement with significant reductions in systolic pulmonary artery pressure (PAP) (51.1 vs. 64.2, p < 0.001), mean PAP (28.4 vs. 35.2, p < 0.001), pulmonary vascular resistance (4.7 vs. 5.9, p = 0.004), and stent gradient (11.2 vs. 33.4, p < 0.001), along with increased patency (84.8% vs. 28%, p < 0.001), and fractional flow reserve (0.84 vs. 0.44, p < 0.001). Over a median follow-up of 331 days (range 45-980), no significant stent stenosis occurred (p = 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.
Insights
Pulmonary artery stenting effectively treats fibrosing mediastinitis by improving blood flow and reducing pressure. This procedure enhances patient mobility and eases symptoms like dyspnea.
Area of Science:
- Cardiology
- Pulmonology
- Interventional Radiology
Background:
- Fibrosing mediastinitis (FM) obstructs pulmonary vessels and airways, complicating treatment and impacting patient health.
- Pulmonary artery (PA) stenting is a potential therapeutic option for managing FM-induced vascular compromise.
- Common comorbidities in FM patients include COPD, tuberculosis, and pneumoconiosis, exacerbating respiratory distress.
Purpose of the Study:
- To evaluate the efficacy and safety of PA stenting in patients with fibrosing mediastinitis.
- To assess the impact of PA stenting on pulmonary hemodynamics, vascular patency, and functional capacity.
- To identify common patterns of PA and pulmonary vein involvement in FM.
Main Methods:
- Retrospective analysis of 30 patients undergoing 49 PA stenting procedures for FM.
- Collection of baseline characteristics, CTPA imaging, stent patency, and hemodynamic data.
- Assessment of functional outcomes including 6-minute walk distance and WHO functional class.
Main Results:
- PA stenting significantly improved hemodynamic parameters, including reduced systolic and mean PAP, and pulmonary vascular resistance.
- Stent placement led to increased PA patency and fractional flow reserve, with sustained patency over follow-up.
- Patients experienced significant improvements in exercise tolerance (6-min walk distance) and WHO functional class, alongside enhanced RV function markers.
Conclusions:
- PA stenting, particularly in the LLPA and RLPA, is a safe and effective treatment for fibrosing mediastinitis.
- The procedure significantly improves pulmonary vascular patency, hemodynamics, and patient-reported symptoms and functional capacity.
- PA stenting offers a valuable therapeutic option for managing the complex vascular complications of FM.
