Native vessel angioplasty as treatment strategy for left internal mammary artery to pulmonary vasculature fistula producing coronary steal phenomenon.

Formation of fistulous connection between internal mammary graft and pulmonary vasculature after coronary artery bypass graft (CABG) is a rare event, which can result in recurrence of symptoms ranging from stable angina to myocardial infarction related to coronary steal. We hereby report a case of a 56-year-old man who was detected to have such a fistulous communication leading to coronary steal as the cause of effort angina 3 years after CABG. Coronary angioplasty and stenting of left anterior descending artery resulted in resolution of symptoms. Native vessel percutaneous coronary intervention as a treatment strategy for internal mammary artery to pulmonary artery fistula has not been reported previously.