Coronary Artery Fistula With a Huge Aneurysm Treated by Transcatheter Coil Embolization
A 75-year-old man presented with chest pain that suggested angina. His only risk factor for coronary artery disease was smoking. He had not experienced chest trauma or thoracic surgery. Cardiac echocardiography revealed severe hypokinesia at the myocardial territory of left anterior descending coronary artery (LAD), and myocardial perfusion scan showed reversible ischemia at the same region. Coronary angiography revealed a fistula at the LAD and a huge aneurysm connected to it (Figure 1A, arrow). Blood was spouting out to the aneurysmal sac (Figure 1A, arrowhead), and the LAD had a narrow portion just distal to the ostium of the feeding artery. Coronary computed tomography angiography (Figure 1C) and 3-dimensional reconstruction imaging revealed that the aneurysmal sac was compressing the mid-LAD (Figure 2, arrow). We dilated the mid-LAD narrowing with percutaneous transcatheter coronary artery ballooning and stenting, and then we embolized the feeding artery to the aneurysm by transcatheter coiling. (Figure 3A). Intravascular ultrasound showed that the extrinsic compression by the aneurysmal sac (Figure 1B) was relieved after coronary stenting and fistula coiling (Figure 3B). Follow-up coronary computed tomography angiography showed a regressed aneurysmal sac and nonvisible dye filling in the sac (Figure 3C). Six months after the procedures, the patient reported no symptoms and was doing well.
The online-only Data Supplement, consisting of movie files, is available with this article at http://circ.ahajournals.org/cgi/content/full/114/24/e631/DC1.