Author + information
- Received June 13, 2016
- Accepted June 20, 2016
- Published online October 10, 2016.
- aDivision of Cardiology, Department of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
- bNorth Carolina Heart and Vascular/UNC Health Care, Raleigh, North Carolina
- ↵∗Reprint requests and correspondence:
Dr. Shriti M. Mehta, University of North Carolina at Chapel Hill, Interventional Cardiology, 160 Dental Circle, CB#7075, 6th Floor, Burnett-Womack Building, Chapel Hill, North Carolina 27599-7075.
Orbital atherectomy was developed to facilitate percutaneous treatment of severely calcified coronary lesions. The most common complications of orbital atherectomy have been dissection, perforation, and no-reflow (1). Although iatrogenic coronary arteriovenous fistula is a rare complication of percutaneous coronary intervention, it has been reported after balloon angioplasty, stent placement, and rotational atherectomy (2–4). We present the first case report, to our knowledge, of an orbital atherectomy–induced fistula between the circumflex artery and coronary sinus.
A 71-year-old woman presented with persistent chest pain and dyspnea despite medical therapy. Cardiac catheterization revealed a calcified 90% proximal to mid circumflex stenosis (Figure 1, Online Video 1). Because an initial attempt to pass an angioplasty balloon was unsuccessful, the patient was referred for atherectomy. The lesion was treated with a CSI Diamondback 1.25 mm orbital atherectomy device (CSI, St. Paul, Minnesota). After placement of 2 drug-eluting stents, persistent contrast staining was noted around the proximal circumflex (Figure 2, Online Video 2). Echocardiography showed no pericardial effusion. The patient was discharged 3 days later, with resolution of her symptoms.
However, she presented 2 months later with progressive dyspnea, edema, and chest tightness. She was found to have moderate pericardial effusion and bilateral pleural effusions. Despite diuresis, she had persistent hypoxemia. Catheterization revealed patent proximal to mid circumflex stents and a fistula between the proximal/mid circumflex artery and the coronary sinus/venous system (Figure 3, Online Video 3). The fistula was successfully excluded with the placement of 2 covered stents (Figure 4, Online Video 4).
This case illustrates a rare complication of the use of orbital atherectomy for treatment of calcified coronary lesions. Operators should be aware that such arteriovenous fistulas can present as a late complication of atherectomy. Closure of the fistula may be performed with covered stents, coil embolization, or vascular plugs.
For supplemental videos and their legends, 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 June 13, 2016.
- Accepted June 20, 2016.
- American College of Cardiology Foundation
- Chambers J.W.,
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