Abstract
BACKGROUND: Coronary artery fistulas (CAFs) are rare anomalies that can cause ischemia, arrhythmias, and sudden cardiac death. Conventional closure techniques often fail in anatomically complex cases. SUMMARY: We present the first-in-human use of a customized, partially covered G-Armor pulmonary artery (PA) stent to manage a left main-to-right pulmonary artery fistula in a patient with Shone complex. The intervention was planned using a three-dimensionally printed model, allowing precise stent customization to avoid obstruction of key pulmonary branches. DISCUSSION: This case shows the feasibility of using customized endovascular devices to address complex CAFs in high-risk patients. The intervention improved antegrade coronary perfusion and clinical outcomes. NOVELTY: To the best of our knowledge, this is the first reported case of a customized partially covered PA stent for CAF management. TAKE-HOME MESSAGE: In anatomically complex and high-risk CAFs, customized stenting offers a viable solution when conventional therapies fail.