Coronary arteriovenous fistula secondary to percutaneous coronary intervention of chronic total occlusion

Area of Science:

• Cardiology
• Interventional Cardiology
• Cardiovascular Medicine

Background:

• Non-ST-elevation myocardial infarction (NSTEMI) is a common cardiac emergency.
• Complications during percutaneous coronary intervention, such as arterial dissection, require careful management.
• Coronary artery anomalies, like arteriovenous fistulas, can present unique clinical challenges.

Purpose of the Study:

• To report a case of iatrogenic left circumflex artery dissection during NSTEMI management.
• To illustrate the successful conservative treatment of a proximal LCX dissection with an associated arteriovenous fistula.
• To highlight the importance of serial angiography and non-invasive assessment in managing complex coronary events.

Main Methods:

• A case report of a 61-year-old female with NSTEMI and lateral ST-T changes.
• Attempted percutaneous coronary intervention of the left circumflex artery (LCX) resulted in proximal dissection.
• Management included intravenous eptifibatide, serial coronary angiography, and a stress echocardiogram.

Main Results:

• The patient developed a proximal LCX dissection during attempted revascularization.
• The dissection plane showed marginal improvement on follow-up angiography.
• A coronary arteriovenous fistula was identified.
• The patient remained hemodynamically stable and asymptomatic.
• A negative stress echocardiogram was noted on follow-up.

Conclusions:

• Conservative management can be a viable option for select cases of iatrogenic coronary artery dissection.
• The presence of a coronary arteriovenous fistula in conjunction with dissection requires careful consideration.
• Maximal medical therapy and close non-invasive monitoring are crucial for long-term patient management post-dissection.