Slides
Closure of Coronary Artery Fistula with a Graft Stent and Correction of Stenosed Left Anterior Descending Artery in the Same Procedure
- Operator : Seung-Jung Park
Closure of Coronary Artery Fistula with a Graft Stent and Correction of Stenosed Left Anterior Descending Artery in the Same Procedure |
- Operator: Seung-Jung Park, MD, PhD, FACC |
A 50-year-old woman was admitted with effort-related chest pain for several months. The coronary risk factor was diabetes mellitus. The EKG showed precordial T-wave inversion and thallium SPECT revealed moderately decreased perfusion defect in the anterior wall. Coronary angiogram showed a diffuse long lesion of the proximal and middle part of the left anterior descending artery (LAD) and a coronary artery fistula originating from a tortuous septal branch of proximal LAD, finally draining to the main pulmonary artery (Figure 1, Figure 2, Figure 3). The procedure was performed with IVUS guidance. We deployed a bare metal stent (Tsunami 3.0 x 20 mm, Terumo Corp) for the middle LAD lesion (Figure 4, Figure 5). Then a 3.0 x 16 mm PTFE covered stent (JOSTENT? JOMED) was deployed in the proximal LAD to seal the ostium of the septal branch supplying the fistula (Figure 6, Figure 7). Adjunctive high pressure balloon dilatation was subsequently performed to maximize the lumen diameter. No residual fistula and shunt flow was found on the final angiographic image (Figure 8, Figure 9, Figure 10). Post-stent IVUS study showed a large CSA proximal to the middle portion of the LAD (Figure 11; A-fisutula opeing at 3 o'clock, B-after covered stent implantation). The covered stent was well positioned and fully covered the septal branch providing the fistula. The antiplatelet regimens included aspirin, clopidogrel for 3 months |
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