Intervention with a handmade closed-loop balloon stent for a pulmonary artery fistula not closed by coil

Abstract Background: Coronary–pulmonary artery fistulas (CPAF) are rare anomalies that may cause coronary steal and clinical symptoms. Coil embolisation is often effective, but residual flow can persist in large fistulas. Case: A 70-year-old male with coronary artery disease underwent coil embolisation for a right coronary–pulmonary artery fistula. Residual flow persisted, leading to exertional dyspnoea. Coronary angiography confirmed incomplete closure. Since a vascular plug was unavailable, a closed-loop balloon-stent technique was performed with guideliner support, achieving complete occlusion. Results: The fistula was successfully closed, eliminating the pathological connection. At 6-month follow-up, dyspnoea had resolved. Conclusions: This case highlights the limitations of coil embolisation in large CPAF and demonstrates the safety and efficacy of a guideliner-assisted closed-loop balloon-stent technique as a practical alternative when plugs are unavailable.