Coil migration during coronary artery fistula transcatheter embolization

Link of Video Abstract: https://youtu.be/qD-dDYr0m2U   Introduction: Coronary artery fistula (CAF) transcatheter coil embolization is very effective in treating symptomatic coronary fistula and has many advantages compared to the surgical approach. Although this procedure is considerably safe, some life-threatening complications, including vessel rupture, coil migration and death, could still happen. We reported an example case of coil migration into the left anterior descending (LAD) artery during transcatheter CAF embolization. Case Description: A 61-year-old man reported recurrent episodes of typical chest pain and a history of inconclusive exercise tests. Computed tomography (CT) angiography revealed a considerable medium size complex coronary fistula from proximal LAD to main pulmonary artery (MPA), which could cause coronary steal syndrome. The patient then underwent CAF transcatheter coil embolization with 3 pushable coils. Upon delivery of the last coil, the coil suddenly migrated into proximal LAD and made the patient feel chest pain with slight ST depression on electrocardiogram (ECG) monitor lead. This coil migration was treated with a coronary stent to pin the coil into the ostial CAF and coronary vessel wall. After the procedure, the chest pain disappeared, and the ST segment on ECG resolved back to baseline. Conclusion: Coil migration is one of the potentially life-threatening complications during transcatheter CAF coil embolization. Careful preparation in choosing the closure technique, selecting coil size, determining the landing zone and using a detachable coil in high-risk CAF anatomy is mandatory to prevent this event.