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Coronary artery fistulae (CAF) can be visualized in nearly 0.25% of patients undergoing catheterization. Early treatment is indicated for preventing potential complications. Transcatheter closure using coil has been considered as the most common method for treating CAFs, but with the risk of recanalization. Onyx, a kind of non-adhesive embolic agent, has been reported for embolization of brain vascular malformations, with excellent results. However, no reports have been published regarding transcatheter closure of coronary artery fistulae (CAF) using this technique.
This study sought to evaluate clinical and angiographic outcomes in a series of 26 patients with CAF underwent endovascular coiling and Onyx embolization.
All cases of CAF treated with combination of coils and Onyx between September 2014 and January 2016, were retrospectively reviewed. The clinical characteristics, angiographic outcomes, and follow-up results were recorded.
A total of 26 patients with CAF (mean age 64.0±9.5 years; range, 44-78 years) underwent 32 transcatheter closure procedures. The mean number of coils used was 3.1±1.2 (range, 2-6), and the average volume of Onyx was 0.4±0.1 ml (range, 0.2-0.6). Immediate post-embolization angiography demonstrated complete occlusion was achieved in 29 procedures (90.6%) and small residual fistulas in 3 procedures (9.4%). The follow-up imaging (median, 11.5 months; range, 9-20) revealed stable occlusion of CAF in 21 cases (80.8%), small recanalization in 4 cases (15.4%), and large recanalization in 1 case (3.8%). Repeat intervention closure was performed in the patient with large recanalization. During follow-up period, there was no procedure-related complications, such as thrombosis event, distal migration of Onyx or coils, and no new symptoms occurred.
Transcatheter closure of CAF in combined of coils with Onyx appears to be safe with a high success rate of complete occlusion. Further large-scale studies with longer follow-up are required to substantiate its efficacy and safety.