Woven coronary artery anomaly presenting as sudden cardiac death

Case report: Woven-like coronary arteries in a patient with polycythemia vera

BACKGROUND

Woven coronary artery (WCA) is a rare and underdiagnosed congenital anomaly that involves multiple thin and tortuous epicardial arterial conduits reassembling distally into a single lumen. Recanalized thrombus may present as woven-like coronary arteries, appearing similar to WCA on angiographic images.

CASE PRESENTATION

A 58-year-old female patient with intermittent chest pain for 5 years and polycythaemia vera (PV) for 8 years. The left anterior descending artery was presented like WCA on coronary angiography and finally confirmed as recanalized thrombus by optical coherence tomography(OCT), which might have been caused by PV. Given the patient's high thrombotic risk of PV and thrombotic changes in the left circumflex artery (LCX), we ultimately chose a conservative treatment without stenting.

CONCLUSIONS

OCT would be needed for the diagnosis and differential diagnosis of woven-like coronary arteries. And physicians should take an appropriate treatment in a personalized way in patients with PV.

Honeycomb-like structure (HLS) in the left anterior-descending coronary artery-recanalized thrombus demonstrated by intravascular ultrasound (IVUS) in a patient with polycythemia vera and thrombocythemia

A 71 year old male patient who experienced acute myocardial infarction (AMI) 4 years ago and had a history of polycythemia vera and thrombocythemia was admitted because acute attack of chronic heart failure. Coronary angiography revealed an unusual filling defect in the middle segment of the left anterior descending (LAD) coronary artery and IVUS showed it is a HLS which is different from dissection or woven coronary artery. We review the recent literature of HLS in this article and further investigations are warranted for the optimal management of HLS.

Case report: Braid-like right coronary artery with chest pain

Braid-like coronary artery is very rare. It is featured by the division of the coronary artery into multiple tortuous small channels that later converge into a normal lumen at any segment of the coronary artery. We presented a case of a 27-year-old male patient with occasional chest pain. In coronary CT angiography (CCTA) and coronary angiography, a braid-like appearance was found in the right coronary artery. After multidisciplinary discussion, it was speculated to be a woven coronary artery (WCA). We conducted a literature review about woven coronary arteries.

Optical coherence tomography-assisted interventional treatment of a woven coronary artery: a case report

BACKGROUND

A woven coronary artery is a rare feature on coronary angiography. Distinguishing woven-like change and recanalization of an occluded artery is difficult.

CASE PRESENTATION

A 59-year-old man was admitted to the hospital for chest tightness. Coronary angiography showed a woven coronary artery at the middle segment of the left anterior descending branch (LAD). The middle segment of the right coronary artery (RCA) exhibited 99% occlusion. A 3.5 × 26-mm drug-eluting stent was implanted in the middle segment of the RCA. One week later, we examined the LAD using optical coherence tomography (OCT). Considering the patient's medical history and the results of OCT, a 2.7 × 38-mm drug-eluting stent was inserted into the LAD. Re-examination by OCT indicated that the stent was well attached to the wall, with no dissection at the edge of the stent. Antiplatelet therapy and statin-based plaque stabilization were continued. No obvious abnormality was found during follow-up one year later.

CONCLUSIONS

OCT can help distinguish woven-like change and recanalization of an occluded coronary artery. The evaluation and formulation of treatment strategies for a woven coronary artery are important.

Case report: Heart failure secondary to myocardial infarction in a fertile woman with woven coronary artery

A 42-year-old female was hospitalized with 2-day history of fever, dyspnea, and chest tightness. Four years ago, she had similar symptoms at the eighth week of gestation. Computed tomography coronary angiography only suggested moderate stenosis, but cardiac MRI indicated myocardial infarction. The coronary angiography demonstrated a woven coronary artery. She underwent successful coronary artery bypass grafting surgery and took medication regularly. Finally, the prognosis was favorable. Cardiovascular events seldom happen in fertile women because of the protection of estrogen, but once it occurs, the potential cause, such as coronary anomaly and other risk factors, should not be overlooked.

Woven Coronary Artery Anomaly: An Incidental Finding and Literature Review

Woven coronary artery anomaly is a rare description of an epicardial vessel segment that divides into multiple intertwining segments with eventual convergence of the distal vessel. We present our case, a 57-year-old male with an incidental woven coronary artery anomaly found during work-up investigations for a possible lung transplant, and we conduct a literature review on woven anomaly cases reported from 1988 to 2021 and provide a thorough analysis of its diversified clinical presentation. Imaging identification and various treatment modalities are also discussed.

Multivessel Woven Coronary Artery Disease

Woven coronary disease is a rare pathology with unknown etiology. Although initially considered benign, recent publications report myocardial ischemia caused by the affected vessel. Since most patients are asymptomatic, long-term follow-up to understand its behavior is mandatory. We report a multivessel woven disease case with documented ischemia that was submitted to coronary artery bypass grafting and remained asymptomatic for two years of follow-up.

Differential Diagnosis, Clinical Characteristics, and Interventions of Braid-Like Coronary Artery: Case Series Analysis Based on Optical Coherence Tomography

Aim

Based on optical coherence tomography (OCT), we aimed to determine the diagnosis, clinical characteristics, and interventions of braid-like coronary arteries, which are rare and tend to be diagnosed as a woven coronary artery (WCA) anomaly.

Methods and Results

We identified braid-like lesions on coronary angiography (CAG) in 7 patients (6 men; median age 47 years; age range 26 to 57 years). All patients were heavy smokers. Four patients were diagnosed with an old myocardial infarction and the other 3 with unstable angina. The braid-like lesions were located in the left anterior descending arteries in 2 patients and in the right coronary arteries in the other 5. TIMI grade 2 flow was observed in all involved vessels. OCT findings of all lesions were consistent with recanalization of organized thrombi, which consisted of septa that divided the lumen into multiple small cavities communicating with each other. No separate three-layered structure could be defined. Based on the significance of the stenosis and its related symptoms, drug-eluting stents were implanted in all of the lesions. All patients experienced symptomatic improvement after the intervention and were followed up event-free for 12 months.

Conclusions

Braid-like coronary arteries are likely to undergo recanalization of organized thrombi rather than WCA according to our OCT findings. The majority of cases affect men who smoke heavily. Percutaneous stent implantation may be beneficial in selected patients when feasible.

Woven coronary artery: A case report

BACKGROUND

Woven coronary artery is an extremely rare disease with unknown etiology. This condition is difficult to diagnosis by traditional methods.

CASE SUMMARY

A 67-year-old male presented to the cardiology department with a history of mild chest pain for 6 mo. Coronary computed-tomography angiography revealed a soft plaque with a 40% stenosis in the right coronary artery (RCA). A linear shadow was seen both on left circumflex (LCX) and RCA. Further coronary angiography showed an 80% regional stenosis in the area proximal of LCX and RCA, and it was divided into different channels with diffuse stenosis. Intravascular ultrasound (IVUS) and optical coherence tomography (OCT) were performed in RCA. These confirmed a woven coronary artery. No stent was implanted. He remained asymptomatic during the 5-year follow-up period.

CONCLUSION

Woven coronary artery can be distinguished from spontaneous dissection and revascularization of thrombosis. IVUS and OCT are useful in obtaining a definite diagnosis, which decreases chances of unnecessary intervention.

A Widow-Maker and a Doppelganger: An Anomalous Case of the Coronaries

The anomalous origin of the left circumflex (LCX) artery from the right coronary sinus is a relatively rare condition. A ‘double’ left anterior descending (LAD) artery is probably the rarest of coronary artery anomalies. We present a case of acute myocardial infarction with a clot and a critical distal stenosis in the left main stem (LMS) supplying a dual LAD and an aberrant origin of the LCX.

Intracoronary Imaging‒Guided Percutaneous Coronary Intervention for Woven Coronary Artery Disease With Chronic Total Occlusion

Woven coronary artery disease is a relatively rare congenital anomaly with unexplained etiology. Herein we presented the first unusual woven case involving all coronary arteries with chronic total occlusion lesion of the left anterior descending artery; describe intracoronary imaging‒guided percutaneous coronary intervention for woven coronary artery disease with chronic total occlusion lesion of the left anterior descending artery; and discuss the complexities involved in intervening with such lesions.

Rheumatic valvular heart disease combined with woven coronary artery: a case report

Background

Woven coronary artery (WCA) is an extremely rare congenital anomaly in which a part of epicardial coronary artery is divided into thin channels, that twist along the axis of the coronary arteries and then merge again as the main coronary lumen. This anomaly is regarded as a benign condition because the blood flow is normal. Very few cases of WCA have been reported.

Case presentation

Herein we report a case of a 44-year-old man who was admitted to our hospital due to 20 years of repeated episodes of heart palpitations, 2 years of shortness of breath after activity, and the symptoms were aggravated for 1 month. He had history of inferior myocardial infarction and atrial fibrillation. Color Doppler echocardiography revealed rheumatic heart disease, severe mitral regurgitation, mild-moderate tricuspid regurgitation, moderate pulmonary hypertension. Coronary angiography revealed 60–85% diffuse stenosis in the middle of left anterior descending artery, 60–90% diffuse stenosis in the middle of left circumflex artery, 30–40% diffuse stenosis in the proximal segment of right coronary artery, and WCA anomaly in the middle, and distal segments of right coronary artery.

Conclusion

The patient successfully underwent prosthetic valve replacement and left anterior descending coronary artery bypass grafting, and had a good recovery after surgery. Further studies are needed to fully understand the disease and determine appropriate treatment options.

Optical coherence tomography and fractional flow reserve guided treatment of woven coronary artery anomaly presenting as acute myocardial infarction: A case report

RATIONALE

Woven coronary artery is a very rare congenital anomaly which may lead to acute coronary syndrome in previous literatures. At present, there is no consensus on the treatment of this coronary artery abnormality.

PATIENT CONCERNS

A 48-year-old male was admitted to the other hospital because of persistent chest pain. The electrocardiogram showed an ST-segment elevation in the v1-v5 lead and the patient was diagnosed with acute anterior myocardial infarction. Coronary angiography revealed 2 lumens in the proximal segment of the left anterior descending artery. Then the patient was transferred to our hospital for further diagnosis and treatment.

DIAGNOSES

The patient was diagnosed with acute myocardial infarction and woven coronary. Transthoracic echocardiography showed left ventricular anterior wall segmental motor abnormalities.

INTERVENTIONS

Optical coherence tomography (OCT) and fractional flow reserve (FFR) guided percutaneous coronary intervention was performed successfully.

OUTCOMES

During the follow-up period of 4 years, the patient remained asymptomatic and no adverse events.

LESSONS

Although the significance of blood flow limitation in one of the lumens detected by FFR is unclear, this strategy of OCT and FFR-guided treatment in woven coronary artery combined with acute coronary events still shows its feasibility.

An unusual etiology of ischemic stroke: Woven coronary artery anomaly

Woven coronary artery is extremely rare and is still not a clearly defined coronary anomaly in which epicardial coronary artery is divided into multiple thin channels at any segment of the coronary artery, and subsequently, these multiple channels merge again in a normal conduit. The described cases were usually incidentally detected and were considered a benign pathology. But, malignant cases with developing complications such as ischemia, infarction, and arrhythmia are increasing in the literature. In this report, we present a young man with a woven right coronary artery associated with a silent myocardial infarction, inferobasal segment acinesia, an area of scarring, and cardioembolic stroke thought from the scar area. Although it is reported as a benign coronary anomaly in the literature, we should be careful especially in terms of the complications that it causes.