An Unusual Entity: Woven Coronary Artery Anomaly

Key words: cardiac imaging, optical coherence tomography

A 52-year-old female was referred to our catheterization lab due to chest pain and stress-induced myocardial inferior ischemia. Coronary angiography revealed an abnormal segment of the right coronary artery (RCA); its lumen was divided into thin channels with a twisting course reassembling into a single normal lumen in the distal segment of the RCA with TIMI 3 blood flow (Figure 1A; Video 1). Optical coherence tomography (OCT) was performed to confirm the presence of a woven coronary artery anomaly (WCAA) (Figure 1B). The similarity of the angiogram to the braided hair gives the name to this entity. WCAA was first described in 1988, and a limited number of cases have been reported since then. Most patients are adult males and the affected vessel is usually the RCA. The etiopathogenesis is still unclear; it is probably a congenital malformation, although some authors have suggested that recurrent spontaneous dissections could be responsible.

WCAA has been considered a benign pathology, as it was usually incidentally detected. However, cases with ischemia, infarction, and arrhythmia are increasing. Recognition is difficult because of its rare nature. Moreover, it can be misinterpreted as recanalized thrombus, spontaneous coronary dissection, or chronic occlusion with bridging collaterals. OCT imaging is challenging due to the tortuosity of the channels. However, it is crucial not only for the differential diagnosis but also to guide the approach. This patient was successfully managed with optimal medical treatment.

From the Interventional Cardiology Unit, University General Hospital of Ciudad Real, Spain.

Disclosure: The authors have completed and returned the ICMJE Form for Disclosure of Potential Conflicts of Interest. The authors report no conflicts of interest regarding the content herein.

The authors report that patient consent was provided for publication of the images used herein.

Manuscript accepted April 22, 2019.

Address for correspondence: María. T. López-Lluva, MD, Avda Obispo Rafael Torija SN, 13005, Ciudad Real, Spain. Email: mtl.lluva@gmail.com