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Outcomes of transcatheter closure for coronary artery fistulas with or without aneurysm: A comparative study
Peijian Wei1, Zuo Pu2, Jeffrey S K Chan3
1Department of Structural Heart Disease, National Center for Cardiovascular Disease, China & Fuwai Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China.
Insights
Transcatheter closure is effective for coronary artery fistulas (CAFs) with or without aneurysms. Larger fistula diameters and coronary-cameral fistulas are risk factors for aneurysms in CAF patients.
Area of Science:
- Cardiology
- Interventional Cardiology
- Vascular Medicine
Background:
- Coronary artery fistulas (CAFs) with aneurysms present unique challenges and require effective treatment strategies.
- Limited data exists on the outcomes of transcatheter closure for CAFs specifically in patients with aneurysms.
Purpose of the Study:
- To compare the outcomes of transcatheter closure in patients with coronary artery fistulas (CAFs) who have aneurysms versus those who do not.
- To identify risk factors associated with the presence of aneurysms in CAF patients.
Main Methods:
- Retrospective analysis of 104 consecutive CAF patients undergoing transcatheter closure from 2010-2023.
- Patients were stratified into aneurysm and non-aneurysm groups for comparative analysis of baseline characteristics and procedural outcomes.
- Multivariate logistic regression was employed to identify independent risk factors for aneurysm presence.
Main Results:
- The aneurysm group (n=56) was younger and had a higher incidence of heart murmurs compared to the non-aneurysm group (n=48).
- Larger fistula diameter and coronary-cameral fistulas (CCFs) were identified as independent risk factors for aneurysms.
- Procedural success rates (75%), fistula recanalization (11.11% vs. 16.67%), and reintervention rates (3.7% vs. 6.25%) were similar between groups.
Conclusions:
- Larger fistula diameters and CCFs are significant risk factors for aneurysm development in CAF patients.
- Transcatheter closure demonstrates comparable efficacy and safety for CAFs with and without aneurysms.
- Post-closure thrombosis is more frequently observed in CAF patients with aneurysms.
Background:
Coronary Artery Fistulas (CAFs) Patients with aneurysm may face severe complications, necessitating prompt treatment. However, data on the outcomes of transcatheter closure in CAFs patients with aneurysm are notably scarce.
Methods:
This retrospective study included all consecutive CAFs patients who underwent transcatheter closure at Fuwai Hospital from January 2010 to December 2023. Patients were divided into two groups based on the presence of aneurysm, and baseline characteristics, anatomical features, and transcatheter closure outcomes were further compared.
Results:
The study ultimately included 104 patients, consisting of 56 in the aneurysm group and 48 in the non-aneurysm group. Patients in the aneurysm group were younger [39.79 (16.35) versus 50.69 (13.31) years, p < 0.001] and more frequently present with heart murmurs (21.43% vs. 6.25%, p = 0.03). Multivariate logistic regression indicated that a larger fistula diameter and the presence of CCFs are independent risk factors for the presence of aneurysm in CAF patients. The procedural success rate (75% vs. 75%, P = 1), fistula recanalization rate (11.11% vs. 16.67%, p = 0.42), and reintervention rate (3.7% vs. 6.25%, p = 0.89) were similar between the aneurysm and non-aneurysm groups.
Conclusion:
A larger fistula diameters and the presence of coronary-cameral fistulas are independent risk factors for the occurrence of aneurysms in patients with CAFs. The outcomes of transcatheter closure are comparable for CAFs patients with and without aneurysm, though post-closure thrombosis within the fistula appears to be more common in patients with aneurysm.
