Embolisation of a complex coronary arteriovenous fistula in a 6 year old child: the need for specialised embolisation techniques

Transcatheter embolisation was performed in a six year old child with a large haemodynamically significant arteriovenous fistula between the left coronary artery and right ventricle. The fistula seemed to fill via a single large septal branch of the left anterior descending coronary artery. This was occluded distally with a detachable balloon backed up by a proximal coil. After this the flow through the fistula was considerably reduced but it still filled via a small diagonal branch that had not been noted previously. This branch was subsequently occluded in its most distal part by a coaxial catheter technique and a single microcoil. Complete occlusion of the fistula was produced and there were no complications.     

Embolisation of a complex coronary arteriovenous fistula in a 6 year old child: the need for specialised embolisation techniques.

Transcatheter embolisation was performed in a six year old child with a large haemodynamically significant arteriovenous fistula between the left coronary artery and right ventricle. The fistula seemed to fill via a single large septal branch of the left anterior descending coronary artery. This was occluded distally with a detachable balloon backed up by a proximal coil. After this the flow through the fistula was considerably reduced but it still filled via a small diagonal branch that had not been noted previously. This branch was subsequently occluded in its most distal part by a coaxial catheter technique and a single microcoil. Complete occlusion of the fistula was produced and there were no complications.     

Coil embolization of a coronary artery to left ventricular fistula using detachable coils

Coronary artery fistulas are rare congenital anomalies noted during coronary angiography of both symptomatic and asymptomatic patients. Percutaneous treatment options have been described previously in case series of varying size. We present the successful percutaneous coil embolization using electrically detachable coils of a symptomatic combined distal left anterior descending artery fistula and distal right coronary artery fistula that join to form a single drainage into the left ventricle. © 2013 Wiley Periodicals, Inc.     

Transcatheter coil embolization of a high-flow coronary artery fistula using 0.052-inch gianturco coils: a case report.

A giant, high-flow coronary fistula is usually difficult to treat by transcatheter coil embolization, but the 0.052-inch Gianturco coil, which is larger and has a stronger shape memory than conventional coils, is now available. Using this device and additional conventional coils, a high-flow coronary artery fistula in a healthy 31-year-old man was successfully embolized. The new Gianturco coil widens the indication for the transcatheter embolization of coronary artery fistulas.     

Bioptome-assisted coil occlusion of coronary artery fistula

We describe a novel technique that allows controlled and precise delivery of single or multiple coils simultaneously for occlusion of a coronary artery fistula using a bioptome passed via a long sheath positioned at the distal end of the fistula. The fistula was balloon occluded distal to the take-off of the native branches before, during and after coil delivery in two patients.     

Successful transcatheter coil embolization of coronary artery to left ventricular fistula associated with absent pulmonary valve with tricuspid atresia in early infancy.

Transcatheter coil embolization for coronary artery to left ventricular fistula was successfully performed in a neonate. At 30 weeks' gestation, fetal echocardiography showed a hypoplastic right ventricle with intact ventricular septum, absent pulmonary valve, tricuspid atresia, and marked distension of the right coronary artery. After birth, the neonate had congestive heart failure and the electrocardiogram showed myocardial ischemic changes in the left ventricular area. Aortography showed a dilated right coronary artery arising from the ascending aorta and draining into the left ventricle. Transcatheter coil embolization was carried out on the 9th day after birth. Since the procedure, no myocardial ischemic changes have been detected. Transcatheter coil embolization is a useful therapy for coronary artery fistula associated with myocardial ischemia.     

Coronary-pulmonary artery fistula arising distal to obstructive coronary lesions.

We report 2 cases of coronary-pulmonary artery fistulae (CPF) arising distal to obstructive coronary artery disease. The fistula in the first patient was in the form of a tortuous dilatation of the distal portion of the right coronary artery and opened into the right pulmonary artery. In the second case, the fistula, a plexus of vessels, arose from the left anterior descending artery and entered the left pulmonary artery. Both the fistulae were successfully ligated at the time of concurrent coronary artery bypass graft surgery.     

Dilation of the septal collateral artery and subsequent cardiac tamponade during retrograde percutaneous coronary intervention using a microcatheter for chronic total occlusion

Microcatheters are often used for percutaneous coronary intervention via the retrograde approach through a collateral channel for chronic total occlusion lesions. Recently, we encountered an alarming case in which a septal collateral artery was dilated after the removal of a microcatheter. This dilated septal artery ruptured spontaneously and resulted in a cardiac tamponade, which was successfully treated by pericardiocentesis and coil embolization.     

Recurrent cardiac tamponade following unusual micro leak after successful closure of the primary leak

Although uncommon, coronary artery perforation is one of the most dreadful complications of percutaneous coronary intervention, which requires prompt, aggressive, and effective management. Perforations induced by coronary guidewires are usually located in the distal part of a coronary artery and commonly managed with embolization. This is an unusual case report of guidewire-induced coronary perforation with recurrent cardiac tamponade, which was managed successfully by coil embolization of both ipsilateral and contralateral coronary arteries via transradial approach.     

Successful management of a distal vessel perforation through a single 8‐French guide catheter: Combining balloon inflation for bleeding control with coil embolization

Coronary perforation is an infrequent, but serious complication of percutaneous coronary intervention (PCI), and is more likely to occur with complex (such as chronic total occlusion) PCI and use of atheroablative devices. For main vessel perforations, the “dual catheter” technique is usually employed in which a balloon is delivered over the first guide catheter to stop bleeding, whereas the covered stent is delivered through a second guide catheter. This is required because the large profile of the currently commercially available covered stents precludes fitting within even an 8‐French guide together with a balloon. However, coil embolization for distal artery wire perforation and collateral vessel perforation can be achieved through a microcatheter that can fit along with a balloon within an 8‐French guide catheter, obviating the need for a second guide catheter. We describe a case in which a distal artery wire perforation was successfully treated using a single 8‐French guide catheter. © 2015 Wiley Periodicals, Inc.     

经导管弹簧圈栓堵法治疗先天性冠状动脉瘘

目的　探讨经导管弹簧圈栓堵冠状动脉瘘的安全性和有效性。方法　总结我院 1999年 5月至 2 0 0 2年 12月 6例 38～ 70岁 (平均年龄 5 0 7岁 )的先天性冠状动脉瘘进行栓堵治疗的患者 ,其中冠状动脉瘘由左冠状动脉至肺动脉 2例、右冠状动脉至肺动脉 2例、右冠状动脉至右下肺静脉及双侧冠状动脉至肺动脉各 1例。结果　 5例 (83 3% )栓堵后完全闭合 ;1例因瘘管迂曲 ,导管到位困难而放弃介入治疗。无手术死亡及并发症。 5例患者经体检和超声心动图随访 3～ 4 6个月 ,无残余瘘 ,无复发。结论　经导管弹簧圈栓堵先天性冠状动脉瘘不用开胸 ,病人易接受 ,安全、有效、方便 ,可作为治疗冠状动脉瘘的一种方法。     

Transcatheter closure of congenital coronary arterial fistulas in adults

OBJECTIVES: We have described our experience with transcatheter occlusion of congenital coronary arterial fistulas in adults. METHODS: Six symptomatic patients, mean aged 41+/-12 years (four men, two women) underwent transcatheter occlusion of fistulas. All had chest pain or dyspnea on exertion. Four of the patients had single fistula. Two of the patients had multiple fistulas. The fistulas originated from the left anterior descending coronary artery in four patients, and from the circumflex artery in two. They all drained into the pulmonary trunk. Graft stenting was used in two patients who had multiple fistulas, and coils in four who had a single fistula. The coils were implanted through a microcatheter, which was passed through a JL 4 8F guiding catheter. RESULTS: Coils were used to completely occlude fistulas. Two 3.0x20 mm coronary graft stents were deployed in the coronary arteries to occlude the fistulas. The procedures were uncomplicated. At follow up, all patients underwent coronary angiography, and one of the patients with coil embolization and one of the patients with graft stenting had small residual flow. Patient's chest pain or dyspneas have resolved after the procedure. CONCLUSION: Transcatheter closure in adults of congenital coronary fistulas with graft stents and coils are safe and effective, and can be regarded as an acceptable alternative to surgery.     

Catheter-based techniques for closure of coronary fistulae

This study details different methodologies of percutaneous closure of arteriosystemic and arteriovenous coronary fistula. Seven patients underwent transcatheter intervention of 10 fistulas, with 7 fistulas successfully closed: 6 with embolic coil devices and 1 with a covered stent obstructing the fistula ostium. The major complication encountered was one death as a result of device recoil into a major epicardial vessel. Percutaneous transcatheter closure of coronary fistulas appears to be simple, facile, and effective. However, device recoil into an undesired arterial segment, while irritating in a noncoronary arterial tree, may be catastrophic when occurring in an epicardial coronary artery.Cathet. Cardiovasc. Intervent. 46:143–150, 1999. © 1999 Wiley-Liss, Inc.     

Novel microsnare successfully used to remove small debris from the right coronary artery

Soutenir (Asahi-Intecc, Nagoya, Japan), a novel microsnare, was used to grip and pull a retrograde guidewire through arteries with chronic total occlusions during percutaneous coronary intervention (PCI). Soutenir can pass through a microcatheter with a 0.020″ lumen, and it can easily enter distal lesions in the coronary artery. Here, we introduce a method for retrieving the tip of a broken intravascular ultrasound (IVUS) catheter by using this microsnare. We present the case of a 64-year-old man who was referred to our hospital for narrowing of the proximal right coronary artery (RCA). After IVUS examination, the catheter was removed from the artery with some difficulty, and the catheter tip broke. The broken tip remained in the RCA and was carried along with the blood to the distal part of the RCA. The conventional gooseneck snare and filter device failed to retrieve the broken tip. However, Soutenir easily passed beyond the catheter tip and reached the distal part of the atrioventricular branch. It snared the tip of the catheter, whereby the tip could easily be removed. Thus, without damaging the RCA, we successfully removed the broken catheter tip from the RCA using this microsnare.     

Coronary fistulas can develop collateral vessels: angiographic follow-up of an embolized giant right coronary artery-superior vena cava fistula in a patient with variant angina

A 54-year-old man was transferred to our emergency department because of acute inferior myocardial infarction. However, ST-segment elevation resolved after intravenous nitrate administration on admission and coronary angiography revealed a nonobstructive atherosclerotic plaque at the mid-portion of the circumflex artery and a giant tortuous fistula from the right sinus of Valsalva to the superior vena cava. The patient was diagnosed with variant angina and coronary arteriovenous fistula after vasodilator treatment and maximal treadmill stress test. After effective medical treatment of variant angina and successful percutaneous coil embolization of the fistula, the patient had not experienced any angina episodes for 1 year. However, control coronary angiography revealed partial persistence of fistula flow because of new collateral vessels, bridging distal and proximal parts of the occluded segment. We present the first coexistence of coronary to superior vena cava fistula and variant angina in the literature. This report also shows the ability of coronary fistulas to develop collateral vessels, like coronary arteries.     

Saphenous vein graft-to-left atrium fistula treated with percutaneous transcatheter embolization with coils

Coronary artery fistulae are rare anomalies that are most commonly congenital and rarely acquired. We present a first case of a vein graft to the left atrium fistula that occurred post coronary artery bypass grafting and was treated with percutaneous transcatheter embolization with coiling. The coil was initially lost in the left atrium, but was successfully retrieved and the fistula was closed. We review the pertinent literature on acquired coronary artery fistulae and their management.     

Closure of a coronary fistula with a transcatheter implantable coil.

Large sized coronary artery fistulas are rare and diagnosed in only 0.05% of adult catheterized patients. Only a minority of these fistulas are operated upon. We describe a percutaneous technique to close a left coronary artery fistula draining into the right atrium in a 30-yr-old male patient. The fistula was closed by implantation of a trefoil coil, inserted through a catheter selectively advanced into the fistula.     

Closure of a coronary fistula with a transcatheter implantable coil

Large sized coronary artery fistulas are rare and diagnosed in only 0.05% of adult catheterized patients. Only a minority of these fistulas are operated upon. We describe a percutaneous technique to close a left coronary artery fistula draining into the right atrium in a 30-yr-old male patient. The fistula was closed by implantation of a trefoil coil, inserted through a catheter selectively advanced into the fistula.     

A novel percutaneous coronary intervention technique for chronic total occlusion: Contralateral angiography with a single guiding catheter

We report two successful cases with a new percutaneous coronary intervention (PCI) technique to treat chronic total occlusion (CTO) by using contra‐lateral coronary angiography with a single guiding catheter (GC) safely. Firstly, a GC was inserted into the coronary artery supplying collaterals and a microcatheter was inserted into the distal side of the coronary artery. Then, the GC was retroflexed and engaged in the targeted coronary artery with CTO. While the contra‐lateral coronary artery was visualized by injection through a microcatheter, a guide wire was controlled and passed through the CTO lesion. Two sheaths insertion were necessary to perform contra‐lateral angiography in CTO PCI. This new technique makes it possible to perform safe contra‐lateral angiography with a single sheath and a single GC. It could reduce vascular access complication rates. © 2015 Wiley Periodicals, Inc.     

Aortocaval fistula after stent-graft repair.

PURPOSE: To report an aortocaval fistula after stent-graft repair and the feasibility of interventional treatment. CASE REPORT: A 78-year-old man with a 61-mm infrarenal aortic aneurysm (AA) was treated successfully with a Zenith bifurcated stent-graft. Three years later, the patient presented with deteriorating renal function and acute bronchial obstruction. Computed tomography showed an aortic diameter increased to 90 mm, dilatation of the inferior vena cava, and a distal type I endoleak. The patient's condition quickly deteriorated, and emergent imaging found a fistula with brisk flow between the aneurysm sac and the left iliac vein within a distal type I endoleak. During emergency endovascular repair, iliac extensions were implanted in the right common iliac artery and left external iliac artery. The left hypogastric artery was coil embolized to exclude flow into the aneurysm sac. After positioning the extensions, cardiac function improved, and the fistula was no longer palpable. The cardiac indices and renal function normalized, and he was discharged 20 days after admission. CONCLUSION: Aortocaval fistulas are a rare complication of AA stent-graft repair and may be successfully treated by interventional means.