Extrinsic left main coronary artery compression in pulmonary hypertension with syncope debut

Extrinsic left main coronary artery (LMCA) compression is a rare condition, often associated with pulmonary artery hypertension. We present the first reported case of extrinsic LMCA compression manifesting as syncope in a 35-year-old woman. Imaging confirmed significant LMCA compression due to pulmonary artery enlargement. Percutaneous coronary intervention with a third-generation stent successfully relieved the obstruction. At five-year follow-up, the stent remained patent without restenosis or fracture. This case highlights the importance of early diagnosis using multimodal imaging and demonstrates angioplasty as a safe, effective alternative for managing LMCA compression in high-risk patients. • First reported case of extrinsic left main coronary artery (LMCA) compression presenting with syncope • Successful third-generation stent placement for left coronary extrinsic compression • Five-year follow-up showed stent patency without restenosis, fracture, or hyperplasia. • Imaging crucial for early LMCA compression detection, especially in pulmonary artery enlargement • Angioplasty offers a safe alternative for high-risk patients with LMCA compression.