Successful percutaneous intervention of the woven coronary a
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Woven coronary artery anomaly is a very rare vascular disease in which the etiology is unclear. The epicardial coronary arteries, in these cases, are separated by thin tunnels and have the shape of a hair braid.

It is considered as a benign anomaly, but may be associated with ischemia and adverse cardiac events.

A 56-year-old female patient was hospitalized with chief complaints of dyspnea and pulmonary edema. Intubation was done due to hemodynamic deterioration and increasing respiratory distress. Acute pulmonary edema was managed with medical therapy. The cardiac markers were not found to be elevated. The patient gave a history of exertional dyspnea for a long time, hypertension and hyperlipidemia. Electrocardiography showed sinus rhythm with left bundle branch block. Ejection fraction was 45% (with modified Simpson's method) with hypokinesia of mid and apical septum, apex.

Coronary angiography showed a normal right coronary artery and left circumflex coronary artery. There was diffuse stenosis from proximal to middle segment of the LAD artery with distal TIMI-II flow. The LAD lesion was evaluated as woven coronary artery anomaly, however, PCI was not done. The patient's dyspnea deteriorated while still under optimal medical therapy. Submaximal effort myocardial perfusion scintigraphy (MPS) was performed and reversible ischemia detected in the anterior wall, septum and apex containing approximately 10% of myocardium. After MPS, PCI was planned for the woven coronary anomaly. After the procedure, TIMI-III flow and optimal patency were achieved. Atorvastatin, nebivolol, prasugrel, acetylsalicylic acid, ramipril and furosemide were given and the patient was discharged without any complication. One month later, exercise stress test was repeated and no sign of ischemia was detected.

Source: https://www.sciencedirect.com/science/article/pii/S2468600X18301762
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