Author + information
- Received April 6, 2016
- Accepted April 22, 2016
- Published online July 25, 2016.
- Wei-Chieh Lee, MD,
- Hsiu-Yu Fang, MD and
- Chih-Yuan Fang, MD∗ ()
- Division of Cardiology, Department of Internal Medicine, Kaohsiung Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Kaohsiung, Taiwan, Republic of China
- ↵∗Reprint requests and correspondence:
Dr. Chih-Yuan Fang, Division of Cardiology, Department of Internal Medicine, Kaohsiung Chang Gung Memorial Hospital, Chang Gung University College of Medicine, 123, Ta Pei Road, Niao Sung District, Kaohsiung City, Taiwan, Republic of China, 83301.
- atherosclerotic plaque
- covered stent
- large coronary fistula
- non–ST-segment elevation myocardial infarction
A coronary arterial fistula is a connection between 1 or more of the coronary arteries and a cardiac chamber or great vessel. This is a rare defect and usually occurs in isolation (1). We report a case of coronary arterial fistula with adjacent atherosclerotic plaque treated with a covered stent in a patient with non–ST-segment elevation myocardial infarction. This 59-year-old man had a medical history of type 2 diabetes mellitus and experienced severe chest tightness. A high serum troponin I level of 3.219 ng/ml was noted, and non–ST-segment elevation myocardial infarction was diagnosed. Coronary angiography showed 3 coronary arterial fistulae at the left main coronary artery proximal and mid left anterior descending coronary artery (Figure 1A). The stenotic lesion with haziness was noted at the mid left anterior descending coronary artery, and the biggest coronary arterial fistula stood aside (Figure 1B, Online Video 1). An intravascular ultrasound study showed severe stenosis with atherosclerotic plaque and the origin of the coronary fistula (Figure 1C, Online Video 2). Recent plaque rupture with some thrombus-related myocardial infarction was suspected. A covered stent (GraftMaster, Abbott Vascular, Santa Clara, California) was deployed for the stenotic lesion and the biggest coronary arterial fistula at the mid left anterior descending coronary artery, which later on resolved the fistula (Figure 1D). The patient was asymptomatic during the 1-year follow-up period. This is an interesting case of covered stent implantation for the combination of coronary arterial fistula and unstable plaque.
In the present case, a coronary arterial fistula was found adjacent to the severe atherosclerotic plaque. Coronary arterial fistula may be associated with myocardial ischemia because of a steal mechanism, and the stenotic plaque may have interfered with coronary flow and led to myocardial infarction. Therefore, it was decided to treat both the coronary arterial fistula and the atherosclerotic plaque in the same procedure.
For supplemental videos, please see the online version of this article.
The authors have reported that they have no relationships relevant to the contents of this paper to disclose.
- Received April 6, 2016.
- Accepted April 22, 2016.
- American College of Cardiology Foundation