Coronary angiogenesis in small-cell lung carcinoma: embolization of a left circumflex artery feeding vessel to a lung tumor and concurrent coronary revascularization.

Abstract

Background: Small-cell lung carcinoma (SCLC) can exhibit exuberant angiogenesis, but direct arterial feeders arising from coronary vessels are exceedingly rare. We report a case of a LCX coronary artery supplying a lung tumor, successfully managed with coil embolization.

Case presentation: A 64-year-old man with SCLC presented with a 7 × 8 cm left hilar mass, dyspnea, pleuritic chest pain, hoarseness, and 18 kg weight loss. Two months after starting chemotherapy, he developed an inferior STEMI. Angiography showed proximal LAD ectasia with an atherosclerotic stenosis, total RCA occlusion (culprit lesion), and ectatic LCX branches perfusing the tumor. The RCA STEMI was addressed first with emergent revascularization, followed by PCI of the LAD and embolization of the tumor-feeding artery. Fractional flow reserve was not assessed, and aspiration thrombectomy was not performed. The LCX feeder was embolized using detachable, fiber-coated platinum microcoils delivered through a microcatheter. Post-embolization angiography confirmed complete occlusion without complications. Two-month follow-up CT demonstrated tumor regression to 4.5 × 4 cm and marked relief of dyspnea, chest pain, and hoarseness. No tissue was available to exclude microscopic tumor emboli, but angiographic features favored plaque-rupture thrombosis rather than malignant embolization.

Conclusion: This case underscores the importance of recognizing coronary feeding arteries in lung cancer and illustrates a multidisciplinary strategy-sequential PCI and targeted embolization-that achieved both oncologic (tumor devascularization and shrinkage) and cardiac (symptom control, revascularization) goals.