Abstract 10907: Woven Coronary Artery: A River With Many Currents

Abstract

Introduction: Congenital coronary artery anomalies can increase the risk of cardiovascular events and sudden death. A woven coronary artery is a rare abnormality with multiple lumens in a single vessel, giving the appearance of complex coronary plaque or a dissection flap on coronary angiography. Clinical Case: A 57-year-old man with group IV pulmonary hypertension and chronic right-sided heart failure presented for consideration of pulmonary endarterectomy. He underwent preoperative coronary angiography which demonstrated nonobstructive disease within the left anterior descending and circumflex arteries and a complex lesion in the right coronary artery (RCA- Figure 1). The lesion was further evaluated using intravascular ultrasound (IVUS) which demonstrated numerous, complex, communicating lumens and fenestrations within a single external elastic lamina suggestive of a woven coronary artery anomaly (Figure 2). This was recognized as a benign abnormality for which the patient was managed medically, and he underwent a successful pulmonary endarterectomy several days later. Discussion: Woven coronary arteries are rare and complex lesions made up of numerous lumens often found in the proximal to mid-RCA. These lesions typically permit normal blood flow and are found incidentally in asymptomatic patients. Woven coronary arteries can be mistaken for complex lesions, dissection, or recanalized thrombus, leading to unnecessary and potentially dangerous percutaneous coronary intervention. Woven arteries should not be treated with angioplasty in the absence of thrombotic occlusion as this can lead to arterial vessel damage. Intracoronary imaging, including IVUS, is vital to differentiate woven coronary arteries from other coronary pathologies. Conclusion: Woven coronary arteries may mimic dissection or recanalized thrombus, but can be promptly recognized as a benign congenital anomaly with intracoronary imaging modalities such as IVUS.