Aslan Vedat, Sural Sefa
Toros University, Vocational School of Health Service, Bahçelievler 1835 sokak. No: 4 Yenişehir, Mersin, 33140, Turkey.
BMC Cardiovasc Disord. 2025 Jul 28;25(1):549. doi: 10.1186/s12872-025-05059-y.
Coronary artery fistulas (CAFs) are abnormal vascular connections that allow blood to drain from another vessel or heart chamber, potentially leading to angina and heart failure. While often discovered incidentally, medium-sized and large CAFs necessitate closure to prevent hemodynamic complications. This case report describes a novel application of the bifurcation 'crush' technique in the treatment of a coronary artery fistula.
A 72-year-old woman was admitted to the emergency department with chest pain and was diagnosed with non-ST elevation myocardial infarction (MI). Coronary angiography revealed severe coronary stenosis and a large fistula. The large fistula was successfully treated by crushing a covered stent. This method treats the coronary fistula as a side branch while identifying the originating vessel as the main vessel. A covered stent is inserted into the coronary fistula, extending to the main vessel. The protruding segment is subsequently crushed via an open-cell drug-eluting stent parked within the main vessel.
This case highlights a different technique for managing large coronary fistulas among nonsurgical options. The use of drug-eluting stents to crush a covered stent effectively manages coronary fistulas, offering an alternative to traditional surgical or percutaneous methods. However, the absence of follow-up imaging limits the ability to confirm long-term stent patency or detect restenosis.
冠状动脉瘘（CAF）是一种异常的血管连接，可使血液从另一血管或心腔引流，可能导致心绞痛和心力衰竭。虽然冠状动脉瘘常为偶然发现，但中大型冠状动脉瘘需要进行封堵以预防血流动力学并发症。本病例报告描述了分叉“挤压”技术在冠状动脉瘘治疗中的一种新应用。
一名72岁女性因胸痛入院，被诊断为非ST段抬高型心肌梗死（MI）。冠状动脉造影显示严重冠状动脉狭窄和一个大的瘘管。通过挤压一个覆膜支架成功治疗了这个大的瘘管。该方法将冠状动脉瘘视为一个侧支，而将起源血管视为主要血管。将一个覆膜支架插入冠状动脉瘘，延伸至主要血管。随后通过置于主要血管内的开孔药物洗脱支架挤压突出部分。
本病例突出了在非手术选择中处理大型冠状动脉瘘的一种不同技术。使用药物洗脱支架挤压覆膜支架可有效治疗冠状动脉瘘，为传统手术或经皮方法提供了一种替代方案。然而，缺乏随访影像学检查限制了确认支架长期通畅或检测再狭窄的能力。
