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Transcatheter coil embolization of coronary artery fistula
Bagrat G Alekyan1, Vladimir P Podzolkov, Carina E Cárdenas
1Department of Interventional Cardiology and Angiology, Bakoulev Scientific Center for Cardiovascular Surgery, Russian Academy of Medical Sciences, Moscow, Russia. b_alekyan@mtu-net.ru
Insights
Coil embolization effectively treated coronary artery-to-cardiac chamber fistulas in 15 pediatric and adult patients, achieving a 93% success rate. This minimally invasive procedure offers a safe and durable solution for these rare vascular anomalies.
Area of Science:
- Cardiology
- Interventional Cardiology
- Vascular Surgery
Background:
- Coronary artery-to-cardiac chamber fistulas are rare congenital or acquired abnormalities.
- These fistulas can lead to significant hemodynamic complications and require timely intervention.
Purpose of the Study:
- To evaluate the efficacy and safety of coil embolization for treating coronary artery-to-cardiac chamber fistulas.
- To assess the long-term outcomes of this interventional procedure.
Main Methods:
- A retrospective analysis of 15 patients (aged 11 months to 44 years) who underwent coil embolization.
- Detailed review of fistula location, procedural success, complications, and follow-up data.
Main Results:
- Complete fistula occlusion was achieved in 14 patients (93%) with one repeat procedure.
- One early death occurred due to femoral artery thrombosis and renal failure.
- Complications included coil migration (2) and femoral artery thrombosis (2).
Conclusions:
- Coil embolization is a highly effective treatment for coronary artery-to-cardiac chamber fistulas.
- The procedure demonstrates a high success rate and acceptable safety profile with long-term durability.
Abstract:
Between December 1982 and August 2001, coil embolization of coronary artery-to-cardiac chamber fistula was attempted in 15 patients aged 11 months to 44 years (mean, 7.2 +/- 2.5 years). The fistulae connected the left anterior descending artery to the right ventricle in 4 patients, the right coronary artery to the right ventricle in 3, the right coronary artery to the right atrium in 3, the circumflex artery to the right ventricle in 2, the circumflex artery to the right atrium in 2, and the right coronary artery to the trunk of the pulmonary artery in 1. Complete fistula occlusion was achieved in 14 patients (93%); one had a residual shunt and underwent repeat embolization one year later, resulting in complete occlusion. There was one early death (7%) in a 4-year-old girl who developed femoral artery thrombosis and acute renal failure. Complications comprised migration of the coil into the pulmonary artery (2), femoral artery thrombosis (2), and perforation of the vessel wall by the guidewire (1) with immediate thrombosis and occlusion of the fistula (no coil was deployed). The 13 survivors with coils were followed up for 0.5 to 13 years; complete occlusion of the fistula was confirmed in all cases.