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

Abstract

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.

Diagnosis and treatment of angiographically unclear coronary lesions

“…28 Nevertheless, they are associated with a higher rate of compromised flow through the side branches during stenting, precisely because of the existence of multiple septa; compromised flow can be avoided by protection of the side branch. 10,25,29 Using OCT in PCI lesions avoids suboptimal treatment results such as malposition, dissection, insufficient stent expansion, and later consequences related to major adverse cardiac and cerebrovascular events. 2,30 Conclusion "Honeycomb-like" structures are rarely encountered in clinical practice because of the difficulty of diagnosis based on coronary angiography findings and the nonspecific clinical symptoms and signs.…”

“…9 In both cases, most of the lumens are extremely small compared with the true lumen of the coronary artery proximal and distal to the site of the altered wall structure, and in many cases, they limit normal blood flow and require revascularization. 6,8,10 The exact pathogenesis of honeycomblike structures is unknown. There are hypotheses regarding dissection and inflammation as complications of atherosclerotic plaques as well as hypotheses regarding thrombus recanalization and neovascularization, tissue substitution after spontaneous dissection, and cardioembolic origin.…”

“…Smoking is considered to be the main trigger for the formation of such lesions because smoking causes endothelial dysfunction and increased prothrombotic activity of platelets. 10,[12][13][14] The predominance of these lesions in men can be explained by the lower prevalence of risk factors for complications of atherosclerotic plaques in women (e.g., plaques rich in lipids, cholesterol crystals, and plaque rupture) and a higher prevalence of healed plaques with positive remodeling in women. 12 However, the representation of the two sexes in lesions of non-atherosclerotic origin cannot be adequately explained.…”

Woven Coronary Artery Anomaly: An Incidental Finding and Literature Review

“…A published case series in 2020 argues that some of the case reports on woven anomalies are misdiagnosed and could be recanalized organized thrombi. It further states that merely doing an angiogram is not sufficient to determine the diagnosis as both these pathological states will present as a “braid-like lesion” [ 15 ].…”

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

“…Woven coronary artery (WCA) is a rare congenital vascular variation with unknown etiology, in which the epicardial coronary artery is divided into channels that bifurcate and weave along the axis of the coronary artery and then merge again as the main coronary lumen ( 1 , 2 ). Although previous cases were usually detected incidentally and WCA was considered a benign anomaly because of its normal blood flow ( 3 ), the challenge for physicians is to recognize, which cases in fact may attribute to the possibility of angina ( 4 ), acute coronary syndrome ( 5 , 6 ) even sudden cardiac death ( 7 ). However, to date, WCA associated with heart failure (HF) secondary to myocardial infarction (MI) has been not reported, especially in fertile women who have a lower incidence of cardiovascular events.…”