463 WOVEN CORONARY ARTERY AN INCIDENTAL FINDING

Abstract

Abstract Introduction Woven coronary artery is a rare congenital vascular anomaly, namely a coronary segment divided into many independent thin channels, which intertwine around the coronary axis for several centimeters, and then re-anastomose distally in a single lumen. The etiology of woven coronary arteries is unknown; however, it is commonly considered a benign condition which only rarely results into myocardial ischemia and acute coronary events Clinical case A 47-year-old man, with history of hypertension and drug addiction, presented to the emergency department due to dyspnea (NYHA IV). The chest x-ray showed bilateral pneumonia with pleural effusion, and depressed left ventricular ejection fraction of 32% with antero-lateral ipokinesia and moderate mitral regurgitation was shown at echocardiography. The electrocardiogram showed right bundle branch block. Troponin levels were elevated, denoting myocardial injury and possibly an acute coronary syndrome; therefore the patient was referred to invasive coronary angiography. The coronary angiogram showed the aspect of“woven coronary artery” both in the right (more frequent) and in the circumflex coronary (Figure 1). As in this case, woven coronary is usually incidentally diagnosed during coronary angiography, in fact the anomaly could not explain this clinical scenario. Sometimes woven coronary can be confounded with dissections, recanalized thrombus and chronic total occlusion with bridging collaterals. In the current case the vessels presented a thrombolysis in myocardial infarction (TIMI) flow grade 3 and there was no coronary occlusion; moreover, the simultaneous multivessel presence of this suggestive angiographic aspect makes the hypothesis of a congenital anomaly more likely. Conclusion Woven coronary artery is a rare vascular anomaly, usually benign. Intravascular imaging, which was not performed in this case, may be helpful in equivocal circumstances to avoid unnecessary and potentially high-risk percutaneous coronary intervention.