Stent Graft for a Coronary Arteriovenous Fistula in Acute Myocardial Infarction

Abstract

The stent graft has recently been used for the treatment of coronary artery aneurysms, perforations, dissection and arteriovenous fistula. An 81-year-old male presented with chest pain of 2-day duration. A 12lead electrocardiogram showed atrial fibrillation and ST-T changes over the precordial leads. A diagnostic left coronary angiogram (CAG) revealed critical stenosis in the proximal left anterior descending coronary artery (LAD) and prestenotic dilatation with large coronary arteriovenous fistula draining into the main pulmonary artery. After predilation, a polytetrafluoroethylene (PTFE) covered stent graft (3.0×16 mm JoStent Graft Master®, JoMed, Germany) for fistula and an additional conventional stent for just below the graft stented site of proximal LAD stenosis were implanted successfully. After stenting, no visible large fistula or remaining stenosis was demonstrated on CAG. The stent graft was deployed with a high success rate. The restenosis rate was not higher than expected for bare stents. However, as subacute occlusion may occur more frequently, long-term ticlopidine or clopidogrel treatment should be required. (Korean Circulation J 2004;34(6):610-614)