Angiography demonstrated coils (arrowheads) from first embolization attempt (A). A telescoping delivery system was created on 2nd catheterization attempt using a 7 Fr 90 cm Flexor^® guiding sheath (Cook Medical LLC, IN, USA) (A) within which a Benchmark™ mother catheter (Penumbra, Inc., CA, USA) was advanced to the mid-right coronary artery (B), a daughter catheter to the distal right coronary artery (C) and a 150 cm LANTERN microcatheter (Penumbra, Inc., CA, USA) into the fistula neck (D). A 14 mm × 34 cm AZUR framing coil (Terumo, NJ, USA) was deployed (E) and subsequently embolized into the fistula (F). A target location was then identified (arrowhead) distal to the posterior descending artery (PDA) takeoff (G). A 16 mm × 60 cm Ruby Standard coil (Penumbra, Inc., CA, USA) was deployed, followed rapidly by a 2nd 16 mm × 60 cm Ruby Standard coil, a 14 mm × 34 cm AZUR framing coil, a 16 mm × 50 cm Ruby Soft coil, an 8 mm × 28 cm AZUR CX coil, a Penumbra packing coil, and an 8 mm × 20 cm AZUR hydrogel coil (H).