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Updated: Jun 4, 2025
Closure of a Patent Foramen Ovale PFO: An Intervention Sequence
Published on: December 23, 2022
Comparison of Embolization Coils and Patent Ductus Arteriosus Occluders for Coronary Artery Fistula Transcatheter
Peijian Wei1, Yihang Li1, Liang Xu1
1Department of Structural Heart Disease, National Center for Cardiovascular Disease & Fuwai Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, People's Republic of China.
Insights
Patent ductus arteriosus (PDA) occluders offer higher acute success for coronary artery fistulas (CAFs) closure compared to coils. Late outcomes remain comparable, making PDA occluders a promising option for CAF treatment.
Area of Science:
- Cardiology
- Interventional Cardiology
- Vascular Surgery
Background:
- Coronary artery fistulas (CAFs) lack dedicated occlusive devices.
- Efficacy and safety data for off-label devices in CAF closure are limited.
Purpose of the Study:
- To compare the efficacy and safety of patent ductus arteriosus (PDA) occluders versus coils for transcatheter closure of CAFs.
- To evaluate procedural success and late outcomes in patients undergoing CAF closure.
Main Methods:
- Single-center retrospective study of 101 patients undergoing transcatheter CAF closure (January 2011-December 2022).
- Patients were divided into two groups: coils (n=35) and PDA occluders (n=66).
- Comparison of demographic characteristics, fistula features, procedural success, recanalization, and reintervention rates.
Main Results:
- PDA occluders group showed a higher acute procedural success rate (87.9% vs. 62.9%, adjusted OR 7.20, p=0.01).
- Aneurysm and large fistula prevalence were higher in the PDA occluders group.
- No significant differences in recanalization (7.8% vs. 20%) or reintervention rates (3.1% vs. 8.6%) between groups.
Conclusions:
- Transcatheter closure of CAFs with PDA occluders yields superior acute procedural success compared to coil embolization.
- PDA occluders demonstrate comparable late outcomes to coils for CAF closure.
- PDA occluders represent an effective alternative for transcatheter CAF closure.
Background And Objectives:
There is no dedicated occlusive device for closing coronary artery fistulas (CAFs), and specific efficacy and safety data of various off-label occlusive devices for CAFs closure are scarce.
Methods:
Patients undergoing transcatheter closure of CAFs from January 2011 to December 2022 were included in the single-center retrospective study. The study population was divided into 2 groups: coils group (n=35) and patent ductus arteriosus (PDA) occluders group (n=66).
Results:
No significant intergroup differences were observed in demographic characteristics except age. The presence of multiple CAF origins (54.3% vs. 4.5%, p<0.001) and multiple draining sites (51.4% vs. 3.0%, p<0.001) were more common in the coils group. In contrast, the presence of aneurysm (72.7% vs. 14.3%, p<0.001), and large fistula (75.8% vs. 37.1%, p<0.001) were more prevalent in the PDA occluders group. The acute procedural success rate of the PDA occluders group was higher compared to that of the coils group (87.9% vs. 62.9%, adjusted odds ratio [OR], 7.20; 95% confidence interval, 1.59-32.64; p=0.01). In addition, no significant intergroup differences were noted in both the recanalization rate (7.8% vs. 20%, p=0.107) and the reintervention rate (3.1% vs. 8.6%, p=0.342).
Conclusions:
Transcatheter closure of CAFs using PDA occluders was associated with significantly higher acute procedural success rates compared to coil embolization with comparable late outcomes.
