Double congenital abnormalities of left anterior descending artery: a technical modification for closing wide neck of aneurysm and fistulae-a case report.

Background: The duplication of the left anterior descending coronary artery and coronary artery-to-pulmonary artery fistulae are infrequent congenital anomalies described in literature. These anomalies can lead to life-threatening conditions such as myocardial infarction, rupture, cardiac tamponade, and heart failure. Case summary: A 73-year-old male with chronic kidney failure was admitted for a preoperative cardiovascular assessment. Initially, he did not report any chest pain. However, while awaiting myocardial perfusion scintigraphy, he developed chest pain and coughing, leading him to present to the emergency department, where his troponin levels were found to be elevated. Coronary angiography and coronary computed tomography angiography showed a dual left coronary artery where one of the left anterior descending arteries completely transforms into a congenital aneurysm and fistula. In order to reshape the aneurysm neck and prevent the migration of coils into the left main coronary artery by creating a landing zone and to reduce the number of coils and the procedure time, two stents were first placed inside the aneurysm neck. Then, the fistula and aneurysm were successfully closed by coil implantation. Discussion: Some case studies and centre experiences recommend interventional closure using cover stents, vascular plugs, and coil embolization techniques for symptomatic fistulae and those resulting in complications. Despite these recommendations, determining the best treatment strategy remains challenging due to the lack of clear guidelines. The novel modified technic consisted of two nested stents and coil embolization to close the aneurysm and fistula and prevent secondary complications due to myocardial infarction.