BACKGROUND AND OBJECTIVES: There is no dedicated occlusive device for closing coronary artery fistulas (CAFs), and specific efficacy and safety data of various off-label occlusive devices for CAFs closure are scarce. METHODS: Patients undergoing transcatheter closure of CAFs from January 2011 to December 2022 were included in the single-center retrospective study. The study population was divided into 2 groups: coils group (n=35) and patent ductus arteriosus (PDA) occluders group (n=66). RESULTS: No significant intergroup differences were observed in demographic characteristics except age. The presence of multiple CAF origins (54.3% vs. 4.5%, p<
0.001) and multiple draining sites (51.4% vs. 3.0%, p<
0.001) were more common in the coils group. In contrast, the presence of aneurysm (72.7% vs. 14.3%, p<
0.001), and large fistula (75.8% vs. 37.1%, p<
0.001) were more prevalent in the PDA occluders group. The acute procedural success rate of the PDA occluders group was higher compared to that of the coils group (87.9% vs. 62.9%, adjusted odds ratio [OR], 7.20
95% confidence interval, 1.59-32.64
p=0.01). In addition, no significant intergroup differences were noted in both the recanalization rate (7.8% vs. 20%, p=0.107) and the reintervention rate (3.1% vs. 8.6%, p=0.342). CONCLUSIONS: Transcatheter closure of CAFs using PDA occluders was associated with significantly higher acute procedural success rates compared to coil embolization with comparable late outcomes.