An iatrogenic coronary arteriovenous fistula causing a steal phenomenon: An intracoronary doppler study

Abstract

Summary:We present the case of a 67-year-old man in whom a guidewire broke at rotablation of the right coronary artery, creating an iatrogenic aneurysmal arteriovenous fistula to the coronary sinus. Successful Doppler wire-guided fistula occlusion by percutaneous coil embolization lead to normalization of coronary blood tlow and relief of the patient's symptoms. Myocardial ischemia in this patient may have been due to a steal phenomenon caused by coronary artery fistulae, as suggested by blood flow velocity data obtained before and after fistula occlusion.

Dutch survey of coronary artery fistulas in adults: Congenital solitary fistulas

“…In the fistula reported by Wexberg et al, intracoronary Doppler flow measurement revealed a high average peak flow velocity (APV) at baseline with loss of coronary flow reserve and after successful PTE of the RCA to coronary sinus fistula, CFR was restored to normal with concomitant reduction of baseline APV [26]. Although they used inappropriate terminology about bstealQ in their report, there was no proof found for coronary steal in the patient mentioned.…”

Coronary Artery Fistula: Single‐Center Experience Spanning 17 Years

“…In this study, 50% of the isolated CAF group had large shunts. At rest, myocardial perfusion is adequate, but becomes inadequate with exercise due to the inability of coronary flow reserve (CFR) to be augmented 15,16 . Chronically elevated basic coronary flow is inversely proportional to CFR and may lead to angina pectoris with normal coronary arteries, explaining why even minor narrowing of the coronaries in the presence of CAF likely leads to the ischemic symptoms.…”

Sequential moderate coronary artery fistula and moderate coronary artery stenosis causing ischemia demonstrated by fractional flow reserve and relieved following percutaneous coronary intervention

“…To explain this phenomenon it has been postulated that coronary steal is responsible for inducing ischemia. This has been previously demonstrated using coronary flow velocities , stress thallium scintigraphy , and fractional flow reserve (FFR) . It has been speculated that the interaction of CAF and mild‐moderate coronary artery stenosis may result in premature development of angina pectoris and ischemia .…”