Is every woven coronary artery benign? Case report

Excerpt

A 59-year-old man was admitted to our hospital with sudden persistent chest pain. His complaint was exertional angina occurring over the previous week. The patient had no cardiac risk factors, other than smoking. On physical examination, he had a blood pressure of 96/63 mmHg and a heart rate of 46 bpm. A 12-lead electrocardiogram showed sinus rhythm with marked ST segment elevation in the inferior leads. Echocardiogram revealed normal ventricular wall motion with a left ventricular ejection fraction of 59%. Biochemical assessment showed values as follows: troponin I 3.1 ng/mL and potassium 4.1 mmol/L. Left coronary angiography revealed an 80% stenosis in the proximal of left anterior descending (LAD) and normal anatomy in the left circumflex artery (LCX). However, right coronary angiography revealed a 100% occlusion before the posterior branch of the left ventricle. Beyond this occlusion, the main lumen was divided into several thin channels having a twisting course in the proximal and middle segments of the right coronary artery (Figs. 1, 2). The Swiss cheese-like structure of the woven coronary artery was observed by OCT (Fig. 3). The patient was successfully managed with CABG.

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