Abstract
BACKGROUND: Iatrogenic coronary fistula is a rare complication during percutaneous coronary intervention. CASE SUMMARY: A 69-year-old woman presented with inferior ST-segment elevation myocardial infarction for which she underwent a primary percutaneous coronary intervention. During the procedure, a communication was noted between the distal right coronary artery and the coronary sinus. The patient was hemodynamically stable. She underwent a computed tomography coronary angiography and echocardiography which confirmed the diagnosis of coronary fistula. She underwent staged procedure for percutaneous coronary intervention, and the fistula flow diminished. The patient remained under follow-up and regular imaging assessment with no concerning signs or symptoms. DISCUSSION: Despite its rarity, iatrogenic coronary fistula during intervention can occur due to intimal balloon inflation, guidewire perforation, and artery-balloon size mismatch. TAKE-HOME MESSAGES: The appropriate treatment for iatrogenic coronary fistula should be determined on an individual-specific basis. A detailed multimodality imaging assessment is required to determine the fistula route and its hemodynamic effect.