Coronary Fistula Presented with Acute Coronary Syndrome Treated by Crushing a Covered Stent

Background Coronary artery fistulas (CAFs) are abnormal vascular connections that allow blood to drain another vessel or heart chamber, potentially leading to angina and heart failure. While often found incidentally, medium-sized and large CAFs necessitate closure to prevent hemodynamic complications. Case Presentation: A 72-year-old woman was admitted to the emergency department with chest pain and was diagnosed with non-ST elevation myocardial infarction (MI). Coronary angiography revealed severe coronary stenosis and a large fistula. The large fistula was successfully treated by crushing a covered stent. This method treats the coronary fistula as a side branch while identifying the originating vessel as the main vessel. A covered stent is inserted into the coronary fistula, extending to the main vessel. The protruding segment is subsequently crushed via an open-cell drug-eluting stent parked within the main vessel. Conclusion This case highlights a different technique for managing large coronary fistulas among nonsurgical options. The use of drug-eluting stents to crush a covered stent effectively manages coronary fistulas, offering an alternative to traditional surgical or percutaneous methods.