Conservatively managed Iatrogenic coronary fistula to the coronary sinus during primary percutaneous intervention
Mahdy, Tarek Khedr, Mahmoud Hoey, Edward Bhatia, Gurbir Ment, Jerome Pulikal, George
Mahdy, Tarek
Khedr, Mahmoud
Hoey, Edward
Bhatia, Gurbir
Ment, Jerome
Pulikal, George
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Publication date
2025-12-11
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Abstract
Background: Iatrogenic coronary fistula is a rare complication during percutaneous coronary intervention.
Case summary: A 69-year-old woman presented with inferior ST-segment elevation myocardial infarction for which she underwent a primary percutaneous coronary intervention. During the procedure, a communication was noted between the distal right coronary artery and the coronary sinus. The patient was hemodynamically stable. She underwent a computed tomography coronary angiography and echocardiography which confirmed the diagnosis of coronary fistula. She underwent staged procedure for percutaneous coronary intervention, and the fistula flow diminished. The patient remained under follow-up and regular imaging assessment with no concerning signs or symptoms.
Discussion: Despite its rarity, iatrogenic coronary fistula during intervention can occur due to intimal balloon inflation, guidewire perforation, and artery-balloon size mismatch.
Take-home messages: The appropriate treatment for iatrogenic coronary fistula should be determined on an individual-specific basis. A detailed multimodality imaging assessment is required to determine the fistula route and its hemodynamic effect.
Citation
Mahdy T, Khedr M, Hoey E, Bhatia G, Ment J, Pulikal G. Conservatively Managed Iatrogenic Coronary Fistula to the Coronary Sinus During Primary Percutaneous Intervention. JACC Case Rep. 2025 Dec 11:106429. doi: 10.1016/j.jaccas.2025.106429. Epub ahead of print.
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