Percutaneous transcatheter embolization in large tortuous coronary artery fistula patient: a case report

Coronary artery fistula is a rare anomaly involving thecoronary artery and a heart chamber or vessel.Percutaneous intervention has been shown to beeffective and safe in fistulas that are small and nontortuous;however, it is not an absolute contraindicationin fistulas that are large and tortuous. We report a delayeddiagnosis of a single, large-diameter, tortuous coronaryartery fistula that manifested as myocardial ischaemia dueto the steal phenomenon in a 49 year old male. Theundesirable connection was successfully obliterated bypercutaneous embolisation, followed by an improvementin symptoms and daily activities. Steal phenomenon is thefundamental mechanism of myocardial ischaemia incoronary artery fistula, as confirmed by improvement insymptoms and coronary artery perfusion followingocclusion of the fistula. Percutaneous catheterization issafe and effective for coronary artery fistula closure, andthe occlusion site should be precise to achieve completeocclusion and prevent complications.