Chronic Ischemia Induced by Woven Coronary Artery Anomaly with Typical Atrial Flutter: Insights from Multiple Imaging Devices

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.

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.

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.

Woven coronary artery anomaly presenting as sudden cardiac death

Woven coronary artery is a rare anomaly characterized by thin channels arising from the coronary artery and reanastomosing at the distal arterial segment. To our knowledge, no data are available currently on the histologic structure of the woven segment. A 39-year-old man presented with sudden atypical chest pain while he was practicing cycling. During the transfer of the patient to the hospital, he suffered cardiac arrest. After 50 min of cardiopulmonary resuscitation, the patient could not return to sinus rhythm and died. At autopsy, the patient presented a woven right coronary artery associated with an old myocardial infarct of the posterior wall of the left ventricle. We describe for the first time a case of woven coronary artery associated with sudden death. This case allowed us to study the histopathology of the channels that make up the malformation. These showed well-conformed walls with absence of breaches. A complete review of the literature on the subject is included.