Transcatheter Closure of Left Circumflex Coronary Artery to Coronary Sinus Fistula.

BACKGROUND

Coronary artery fistula is a rare condition with variable presentations. Although traditionally managed surgically, percutaneous intervention is a viable option for high-risk patients.

CASE SUMMARY: We report the case of a 65-year-old man with reduced left ventricular ejection fraction (25%) due to a left circumflex artery to coronary sinus fistula. He underwent successful percutaneous coil embolization using 3-dimensional-shaped platinum-based bare-metal coils.

DISCUSSION: We present an alternative treatment in a high surgical risk patient with a distal left circumflex artery to coronary sinus fistula, a common phenotype for this rare condition. Despite elevated myocardial infarction risk due to distal location and potential side branch occlusion, percutaneous closure was successful. Overall, percutaneous approaches offer high success rates and low recurrence, highlighting the importance of a heart team in individualized management.

TAKE-HOME MESSAGE: Three-dimensional-shaped platinum-based bare-metal coils show promise, but their off-label use highlights the need for standardized protocols and long-term outcome data.