PMC5480679_01
Coronary angiography depicting the severely tortuous coronary artery fistula originating from the proximal left anterior descending artery.
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Diagnostic coronary angiography revealed a severely tortuous coronary artery to pulmonary artery fistula originating from the proximal part of the left anterior descending artery (LAD; Figure 1).
Multi-detected computed tomography demonstrating the coronary artery fistula.
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Multi-detector computed tomography was also performed to observe the anatomy of the LAD and the coronary fistula (Figure 2).
Fluoroscopy during the coil implantation: (a) the 2.5-Fr Renegade -18 microcatheter (Boston Scientific, Natick, MA, USA) could not pass the first bend without the support of the GuildeLiner; (b) when the GuideLiner catheter (lined arrow) was advanced to the entry point of the fistula, the Renegade microcatheter (dotted arrow) easily reached the distally dilated portion of the fistula; and (c) 2-mm Interlock  coil being delivered to the dilated part of the fistula with the support of the GuildeLiner.
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However, when we tried to deliver the 2.5-Fr Renegade -18 microcatheter (Boston Scientific, Natick, MA, USA), it could not pass the first bend (Figure 3(a); Supplementary Movie 1). This "Mother-child-grandchild" technique provided enough support to introduce the Renegade microcatheter into the distally dilated portion of the fistula over the wire (Figure 3(b); Supplementary Movie 2). With the secured system, we initially delivered a 2-mm Interlock  coil into the dilated part of the fistula, followed by two 2-mm Interlock  coils (Figure 3(c); Supplementary Movie 3).
Final coronary angiography. It shows complete obliteration of the coronary artery fistula.
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The final angiogram revealed the complete obliteration of the CAF, resulting in improved flow to the distal portion of the LAD (Figure 4; Supplementary Movie 4).