A case report of an iatrogenic coronary cameral fistula treated by retrograde percutaneous coronary intervention

Abstract

Background Acquired coronary cameral fistula is an extremely rare condition that involves an abnormal communication between a coronary artery and a cardiac chamber. It usually occurs after chest trauma or cardiovascular interventions, such as percutaneous coronary intervention (PCI) and is associated with various outcomes, ranging from a stable status to haemodynamic instability. Acquired coronary cameral fistula frequently arises from the right coronary artery and drains generally into the right ventricle. Case summary We report the unusual case of a 56-year-old male patient referred to an invasive cardiology centre for a suspected left anterior descending (LAD) coronary–left ventricular (LV) fistula resulting from a primary PCI for an anterior ST-elevation myocardial infarction. Here, the confirmed LAD–LV fistula was successfully treated by retrograde PCI with covered stent implantation. Clinical and angiographic outcomes were favourable at 1-month follow-up. Discussion Coronary cameral fistula can be a severe complication of primary PCI. Various treatment strategies can be considered based on haemodynamic status and anatomical features. In the case described herein, the use of a retrograde approach led to permanent fistula closure and complete revascularization.

Iatrogenic Arteriovenous Fistula Secondary to Coronary Artery Dissection Caused by Contrast Injection Into a Chronically Occluded Right Coronary Artery

“…The clinical manifestations of CAVF vary depending on the etiology of the fistula and the severity of left to right shunting; however, the majority of CAVF in adults are asymptomatic [1]. There have been prior published case reports of iatrogenic CAVF and CCF that developed following various coronary artery interventions (Table 1 [2,[6][7][8][9]). The more common causes of iatrogenic CAVF and CCF include coronary perforation during stenting and guidewire-induced trauma [6,8].…”

“…There have been prior published case reports of iatrogenic CAVF and CCF that developed following various coronary artery interventions (Table 1 [2,[6][7][8][9]). The more common causes of iatrogenic CAVF and CCF include coronary perforation during stenting and guidewire-induced trauma [6,8]. Ohayon et al reported the development of a LAD-toleft ventricle fistula following primary PCI for an anterior ST-elevation myocardial infarction [6].…”

“…The more common causes of iatrogenic CAVF and CCF include coronary perforation during stenting and guidewire-induced trauma [6,8]. Ohayon et al reported the development of a LAD-toleft ventricle fistula following primary PCI for an anterior ST-elevation myocardial infarction [6]. Additionally, recent technique advancements have allowed for an increase in the number of performed CTO interventions.…”

“…The main causes of acquired CAVF include myocardial infarction, chest trauma, coronary artery aneurysm or dissection, coronary angioplasty, and coronary artery bypass grafting (CABG) [2,4,5]. Although rare, CAVF is a known complication of percutaneous coronary intervention (PCI) [6,7]. CAVF caused by coronary dissection due to contrast injection during diagnostic angiography is a very rare complication.…”

A rare case report of the successful withdrawal of a stent balloon that failed to deflate

“…Currently, more than 500,000 PCI procedures are performed annually worldwide [ 4 ]. Although many stent implantation operations are carried out successfully every day, the occurrence of a rare but potentially fatal situation during PCI should always be kept in mind [ 5 ].…”