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A 64-year-old Caucasian male with a history of coronary artery bypass grafting (CABG) [internal mammary artery (IMA) graft to the left anterior descending artery (LAD) and saphenous vein graft to right posterior descending artery (PDA)], presented with stable angina with a positive treadmill exercise test. Coronary angiography (CAG) documented occlusion of both middle LAD and IMA grafts (Figure 1, panel A); no significant lesions were found in the circumflex artery or the saphenous vein graft. The CAG performed prior to surgery is shown in Figure 2. After a myocardial perfusion scintigraphy confirming viability in LAD territory, an angioplasty was performed. A new large vessel was visible after mid-LAD dilatation (Figure 1, panel B, supplementary film 1). The images were suggestive of a fistula or a shunt. A 4.0×18-mm drug-eluting stent was successfully implanted. The patient remained stable throughout the procedure.

Acquired fistula from left anterior descending artery to coronary sinus: An unusual finding during percutaneous coronary intervention