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Coronary artery fistulae (CAF) are uncommon and are reported in 0.25% of patients undergoing routine coronary angiography. The combination of severe coronary artery disease and a CAF was rare.A 76-year-old man presented unstable angina.Coronary angiography showed a subtotal occlusion lesion and a CAF at left anterior descending artery.The combination of transcatheter coil embolization and a drug-eluting stent was used for this problem.The patient was symptom-free and had regularly followed up as an outpatient for three years.The combination of a CAF and atherosclerotic change in the same site of the coronary artery is unique. It is feasible to solve the combination of CAF and severe coronary atherosclerotic lesion by transcatheter coil embolization and stent implantation. A big case series study is necessary to evaluate the safety and efficacy of the technique of transcatheter coil embolization and stent implantation in the patients with severe coronary atherosclerotic lesion and a CAF.