Iatrogenic coronary arteriovenous fistula during percutaneous coronary intervention: unique insight into intra-procedural management

Unrecognized perforation into the anterior interventricular vein complicating PCI for anterior STEMI: An unexpected detour

Large iatrogenic coronary artery perforations require rapid management; however, operators must be able to recognize guidewire perforation into cardiac veins in order to avoid causing further complications with standard salvage strategies.

Coil Embolization of Coronary-Cameral Fistula Complicating Revascularization of Chronic Total Occlusion

Traumatic vessel perforation is a potential complication of chronic total occlusion (CTO) percutaneous coronary artery intervention (PCI). A rare consequence of this complication is a coronary-cameral fistula. The management of this condition is not well elucidated. Herein, we present such a case of symptomatic left anterior descending to the right ventricle (LAD-RV) fistula which was treated with coil embolization.

Coronary-Cameral Fistula Caused by Guidewire Trauma and Resolved by Coil Embolization

A 57-year-old woman presented with effort angina. A coronary angiogram revealed critical 2-vessel disease, for which she subsequently underwent percutaneous coronary intervention. During angioplasty, a coronary guidewire-inadvertently passed into the right ventricle through the septal branches of the posterior descending coronary artery-caused a coronary artery-to-right ventricular fistula. This fistula was successfully closed percutaneously by coil embolization. To our knowledge, this is the first report of a case in which a coronary artery-to-right ventricular fistula caused by a guidewire was managed successfully by coil embolization.

Successful management of iatrogenic coronary arteriovenous fistula developed during chronic total occlusion intervention

There have been some reports of iatrogenic coronary arteriovenous fistula (AVF) developing during percutaneous coronary intervention (PCI). PCI for chronic total occlusion (CTO) is more challenging due to a higher rate of procedural failure and increased risk of periprocedural complications. Recently, the coronary CTO guidewire has made rapid strides and revolutionized the procedure to increase high success rates for CTO revascularization. Simultaneously, as the number of CTO interventions increases, more complicated cases have also been reported. We report a case of huge iatrogenic left circumflex artery-to-posterior vein of left ventricle fistula resulting from unexpected penetration of CTO guidewire into cardiac vein during CTO intervention, which was successfully closed by a covered stent. Although controversies still exist concerning the closure of iatrogenic AVF in asymptomatic patients, especially when it drains into a third space including cardiac chambers or venous system, we decided to perform the closure of iatrogenic AVF by covered stent due to relatively bigger AVF size which was generated immediately following balloon angioplasty.