Coronary Arteriovenous Fistulas Mimicking Coronary Perforation After Chronic Total Occlusion Recanalization

https://e-kcj.org A 65-year-old female with stable angina presented with chronic total occlusion (CTO) of the distal right coronary artery (RCA) (Figure 1 and Supplementary Video 1). Coronary intervention of the distal RCA-CTO was performed via the antegrade approach. After successful crossing the CTO lesion gently with a soft guide wire (NEO's Sion black; Asahi, Aichi, Japan), the leakage of contrast media through multiple tiny channels at the posterior descending coronary artery was noted (Figure 2 and Supplementary Video 2). It was initially misinterpreted as coronary perforation, leading to prolonged ballooning of the leakage site without changes in leakage appearance. She was stable without evidence of pericardial effusion by echocardiography, indicating coronary arteriovenous fistulas. The RCA lesions were treated with two drug-eluting stents (Orsiro 2.5×40 mm; Biotronic, Bulach, Switzerland). Final angiogram showed arteriovenous fistulas between RCA and coronary sinus, which mimicked coronary perforation (Figure 3 and Supplementary Video 3).