A Simple, Low-Cost and Effective Technique for Percutaneous Closure of a Coronary Artery Fistula: A Closed-Loop Balloon–Stent System

Abstract Coronary artery fistulas (CAFs), rare anomalies of coronary vasculature, often remain asymptomatic but can lead to complications necessitating intervention. We report a case of a 79-year-old man presenting with chest pain and dyspnea. Diagnostic workup revealed atrial fibrillation, severe mitral regurgitation, and a CAF connecting the circumflex artery to the left atrium. Given high surgical risk, percutaneous closure was chosen. Utilizing a closed-loop balloon–stent technique, a stent was positioned at the fistula's ostium, effectively ceasing flow. The patient was discharged after 5 days, reporting symptom relief at 3-month follow-up. Our experience demonstrates the feasibility and cost-effectiveness of this technique, which can be readily implemented using standard materials available in catheterization laboratories. The closed-loop balloon–stent method offers a compelling alternative to surgical closure, particularly in patients with elevated surgical risks. This technique holds advantages over other percutaneous methods, such as coil embolization or vascular plug, due to its simplicity, affordability, and lower risk of coronary thrombosis. In conclusion, percutaneous closure with the closed-loop balloon–stent technique presents a viable approach for managing symptomatic CAFs, offering an attractive option for patients with limited surgical options. This method's practicality and affordability render it an appealing alternative in appropriate cases, highlighting its potential to improve patient outcomes and enhance overall management strategies.