Coronary artery fistulas are rare abnormalities of artery termination. Most of the coronary fistulas are congenital, acquired forms may rarely due to atherosclerosis. The diagnosis of these anomalies increased with the routine use of coronary angiography and multi detector computed tomography in the investigation of chest pain. We report two rare cases with multiple coronary artery fistula developed in the right coronary artery which is severely occluded, diagnosed when performing a coronary angiography for acute coronary syndrome. The aim of reporting these cases is to emphasize the involvement of severe atherosclerosis in development of acquired multiple coronary artery fistulas.