Transcatheter Coil Embolization of Single Coronary Artery Fistula Using the Occlusion Test

Figure 1

(a) 320-row coronary CTA. The single coronary artery view shows the anterior course of the separate right coronary artery coming off the LAD. This is the anterior view. (b) Selective coronary angiography of the LMT shows the LAD and the LCX with weak contrast effects and a CAF with “multiple caliber change” of the RCA to the right ventricle (arrowhead). (c) Occlusion test on the proximal site of CAF using an occlusion balloon (arrowhead). (d) Engaged microcatheter in the distal RCA and embolization using a detachable coil. (e) One year after coil embolization, selective LMT coronary angiography clearly distinguishes the contrast effect of the LAD and LCX, the sinus node branch branching from LCX (white arrow), and right ventricular branches from the proximal side of the RCA (asterisks). The proximal end of the coil-embolized CAF formed a thrombus and occluded (arrowhead). CAF: coronary artery fistula; CTA: computed tomography angiography; LAD: left anterior descending coronary artery; LCX: left circumflex coronary artery; LMT: left main coronary trunk artery; RCA: right coronary artery.

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