Management of Medium to Giant Coronary Artery Fistulas

Coronary artery fistulas are rare and may present with varied symptoms depending on the size and hemodynamic burden of the shunt. The current guidelines provide limited specificity regarding management. We report a single-center experience with 6 adult patients who presented with symptomatic coronary artery fistulas, describing their clinical presentation, imaging findings, procedural strategies (including transcatheter and surgical approaches), and outcomes. This case series highlights the importance of a multimodality imaging approach and a tailored transcatheter or surgical strategy based on fistula size and anatomy.