Blind Fistulous Pouch After Coronary Artery Fistula Repair: A Rare Cause of Stroke in Adolescence

Coronary artery fistulas (CAFs) are rare, anomalous connections between a coronary artery and cardiac chamber or great vessel. Closure is often indicated to treat significant shunts or prevent complications, typically via surgical ligation or transcatheter device occlusion.

An adolescent with a history of a repaired CAF presented with an ischemic stroke. Her work-up revealed a residual fistulous pouch. Etiology was presumed cardioembolic from a thrombus within the pouch, and she underwent transcatheter coil embolization.

Long-term complications after repair occur in approximately 15% of cases with thrombotic events being the most common and serious. This case highlights a stroke after CAF repair, with advanced imaging critical in diagnosis and management.

Long-term management of CAF is complex and ongoing. High-quality advanced imaging is paramount to diagnose and prevent complications such as thromboembolic events and coronary obstruction. Cardiac computed tomography angiography with a fistula protocol was instrumental in diagnosis, intervention planning, and postintervention follow-up.