Primary pulmonary hypertension is often associated with angina-like chest pain of uncertain etiology. Left main coronary artery compression by the pulmonary artery is a treatable cause of angina and should be considered in these patients. We describe a patient presenting with primary pulmonary hypertension, clinical angina and extrinsic compression of the left main coronary artery by the pulmonary artery, who was treated with direct stenting.