Woven left anterior descending coronary artery imaging with computed tomography

Woven Coronary Artery Anomaly: An Incidental Finding and Literature Review

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.

Multivessel Woven Coronary Artery Disease

Woven coronary disease is a rare pathology with unknown etiology. Although initially considered benign, recent publications report myocardial ischemia caused by the affected vessel. Since most patients are asymptomatic, long-term follow-up to understand its behavior is mandatory. We report a multivessel woven disease case with documented ischemia that was submitted to coronary artery bypass grafting and remained asymptomatic for two years of follow-up.

Woven coronary artery anomaly presenting as sudden cardiac death

Woven coronary artery is a rare anomaly characterized by thin channels arising from the coronary artery and reanastomosing at the distal arterial segment. To our knowledge, no data are available currently on the histologic structure of the woven segment. A 39-year-old man presented with sudden atypical chest pain while he was practicing cycling. During the transfer of the patient to the hospital, he suffered cardiac arrest. After 50 min of cardiopulmonary resuscitation, the patient could not return to sinus rhythm and died. At autopsy, the patient presented a woven right coronary artery associated with an old myocardial infarct of the posterior wall of the left ventricle. We describe for the first time a case of woven coronary artery associated with sudden death. This case allowed us to study the histopathology of the channels that make up the malformation. These showed well-conformed walls with absence of breaches. A complete review of the literature on the subject is included.

Chronic Ischemia Induced by Woven Coronary Artery Anomaly with Typical Atrial Flutter: Insights from Multiple Imaging Devices

A 75-year-old man with a 120-bpm tachycardia and typical atrial flutter was admitted. Echocardiography showed a dilated left ventricle with anterior and apical wall akinesia. Tachycardia was terminated with cavotricuspid isthmus ablation. Multiple imaging findings revealed a woven coronary artery anomaly (WCAA) in the left anterior descending artery. Stress myocardial perfusion imaging was performed after ablation in the sinus rhythm and revealed stress-induced ischemia and a fixed low uptake in the WCAA territory. WCAA is generally regarded as a benign condition; however, compromised blood flow within the anomaly, caused by tachycardia-related diastolic shortening, may induce ischemia.