Transcatheter Coil Embolization

Coronary artery fistulae (CAF) are defined as an abnormal connection between a coronary artery and another luminated vascular or nonvascular organ. Most cases are small and remain asymptomatic. Multiple fistulae involving both coronary arteries are uncommon. A 49-year-old man presented with persistent, progressive, nonexertional chest pain. Coronary computed tomography angiography revealed multiple anomalous CAF draining into a large aneurysm that connected to the pulmonary sinus. The patient underwent percutaneous coronary angiography and transcatheter coil embolization of the aneurysm with 12 coils placed. Symptomatic CAF require intervention to prevent the development of complications. The transcatheter approach is associated with a lower rate of complications and fistula recurrence compared with open-heart surgery. This case illustrates the effectiveness of transcatheter coil embolization in the treatment of coronary artery to pulmonary sinus fistulae.