title: Pulmonary stenting for the treatment of sarcoid induced pulmonary vascular stenosis.
abstract: BACKGROUND
  The best treatment of patients with external pulmonary vascular compression due to advanced sarcoidosis is unknown.
  
  
  OBJECTIVE
  To report a single-center experience of percutaneous treatment for pulmonary vascular stenosis caused by external compression due to advanced sarcoidosis.
  
  
  METHODS
  We report a case series of 5 patients with biopsy confirmed advanced sarcoidosis, seen at our academic institution with worsening dyspnea despite increase of immunosuppressive therapy. All patients were evaluated by a multidisciplinary team (cardiology, pulmonary and radiology) using a multi-modality approach, including chest-computed tomography angiography, ventilation/perfusion scintigraphy, pulmonary function test, 6-minute walk test and heart catheterization.
  
  
  RESULTS
  Three out of five patients underwent pulmonary artery or vein angioplasty and stenting resulting in symptomatic improvement: Patient 1 had persistent symptomatic improvement measured by subjective and objective methods at 30 months; patient 2 required re-intervention due to recurrent pulmonary vein stenosis at 6-months followed by persistent improvement; and patient 3, had a procedure complicated with in-stent thrombosis requiring thrombolysis and anticoagulation with improvement. The remaining two patients were medically treated because underlying thromboembolic disease (patient 4) and diffuse pulmonary vein stenosis not amenable to percutaneous intervention (patient 5).
  
  
  CONCLUSIONS
  Pulmonary vascular stenosis from external compression can be a rare but unrecognized caused of worsening symptoms in advanced sarcoidosis. Pulmonary vascular angioplasty and stenting can provide clinical benefit in select patients.
authors.affiliation: Emory University. jfcondado@emory.edu.
authors.forename: Jose F
authors.initials: JF
authors.lastname: Condado
authors.forename: Vasilis
authors.initials: V
authors.lastname: Babaliaros
authors.forename: Travis S
authors.initials: TS
authors.lastname: Henry
authors.forename: Brian
authors.initials: B
authors.lastname: Kaebnick
authors.forename: Dennis
authors.initials: D
authors.lastname: Kim
authors.forename: Gerald W
authors.initials: GW
authors.lastname: Staton
mesh_terms: D000328:Adult; D000368:Aged; D017130:Angioplasty / Q000295:instrumentation*; D001157:Arterial Occlusive Diseases / Q000175:diagnosis / Q000209:etiology / Q000628:therapy*; D006328:Cardiac Catheterization; D000072226:Computed Tomography Angiography; D003251:Constriction, Pathologic; D005080:Exercise Test; D005260:Female; D006801:Humans; D007166:Immunosuppressive Agents / Q000627:therapeutic use; D008297:Male; D008875:Middle Aged; D055420:Perfusion Imaging; D010690:Phlebography / Q000379:methods; D011651:Pulmonary Artery / Q000000981:diagnostic imaging; D011668:Pulmonary Veno-Occlusive Disease / Q000175:diagnosis / Q000209:etiology / Q000628:therapy*; D012008:Recurrence; D019233:Retreatment; D017565:Sarcoidosis, Pulmonary / Q000150:complications* / Q000175:diagnosis / Q000188:drug therapy; D015607:Stents / Q000009:adverse effects; D013997:Time Factors; D016896:Treatment Outcome
chemical_list: D007166:Immunosuppressive Agents
keywords: pulmonary stenting; sarcoidosis; vascular stenosis