[Percutaneous treatment of coronary artery fistula: a tailored strategy is needed]

Area of Science:

• Cardiology
• Interventional Cardiology
• Vascular Medicine

Background:

• Coronary artery fistula (CAF) is an uncommon congenital or acquired anomaly.
• Symptomatic or large CAFs often require intervention to prevent complications.
• Treatment strategies must consider individual fistula anatomy.

Observation:

• A male patient presented with worsening exertional angina.
• Coronary angiography identified a fistula between the left anterior descending (LAD) artery and the pulmonary artery, alongside significant LAD stenosis.
• The patient underwent successful percutaneous coronary intervention (PCI) with stenting of the LAD and subsequent coil/plug embolization of the CAF.

Findings:

• Post-procedure imaging confirmed complete occlusion of the CAF.
• The LAD stent remained patent, and coronary flow reserve was normalized.
• The combined PCI and embolization approach proved effective in managing this complex case.

Implications:

• This case highlights a feasible, safe, and successful treatment strategy for symptomatic coronary artery fistulas.
• Tailoring treatment to specific CAF anatomy is crucial for optimal outcomes.
• Interventional techniques can effectively manage complex coronary artery anomalies with favorable long-term results.