Woven Coronary Artery Anomaly: An Incidental Finding and Literature Review

Abstract

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.

Woven Coronary Artery with acquired etiology: the natural history documented by serial angiography and optical coherence tomography

“…However, there is lack of data showing that WCA has a genetic predisposition or hereditary characteristic. The OCT image features of WCA is summarized as follows: (1) Intertwined thin channels separated by brous tissue without crosscommunications among them; (2) Undisrupted arterial wall integrity without dissection; and (3) High signal intensity and low signal attenuation [1] . Although it is not conclusive, no cross-communications is proposed as a key feature in distinguishing congenital WCA from other etiologies, such as thrombus recanalization [1] .…”

“…In the past, WCA was deemed to be a benign abnormality and usually do not need intervention [8] . It is now recognized that WCA may lead to ischemia and even myocardial infarction and surgical or percutaneous revascularization is indicated in such patients [1] . The literature review of case reports (37 cases) showed that 24 (50.4%) cases were single vessel disease, and 18 (48.6%) cases underwent revascularization.…”

“…The literature review of case reports (37 cases) showed that 24 (50.4%) cases were single vessel disease, and 18 (48.6%) cases underwent revascularization. Among them, 5 (13.5%) cases received coronary artery bypass graft (CABG) and 13 (35.1%) cases underwent percutaneous coronary intervention (PCI) [1] . Thus, PCI is a therapeutic option for most of WCA patients with documented ischemia when the anatomy is suitable.…”

“…It is angiographically characterized by that the epicardial coronary artery is divided into multiple thin channels at the proximal segment and converged together in the distal segment, with a TIMI III distal blood ow [2] . Since the rst case report, fewer than 40 cases of WCA have been reported [1,3] . Both congenital and acquired origins were considered for WCA.…”

“…Woven coronary artery (WCA) is a rare anomaly and the exact etiology is still unknown [1] . It is angiographically characterized by that the epicardial coronary artery is divided into multiple thin channels at the proximal segment and converged together in the distal segment, with a TIMI III distal blood ow [2] .…”