Differential diagnosis and intervention for braid-like coronary artery – case series analysis based on intracoronary artery imaging

Abstract Background Case reports on braid-like coronary arteries, often diagnosed as Woven Coronary Artery, are accumulating. However, the diversity of manifestation of such lesions has caused great confusion. Methods Consecutive patients admitted to Fuwai hospital with braid-like lesions on coronary angiography (CAG) were included. Intracoronary optical coherence tomography (OCT) was performed to verify the lesion nature. Major cardiovascular events were recorded in 12 months when a control CAG was recommended. Results From January 2018 to June 2019, braid-like lesions were identified in 6 patients (5 male) with average age of 45.3 years. All patients were transferred from lower-level hospitals. Five patients were current heavy smokers, and 4 patients had an old anterior myocardial infarction history. The braid-like segments were found in right coronary artery of 4 patients and in left anterior descending artery of the other 2 patients. Of these 6 braid-like lesions, 3 were culprit of coronary adverse events, and the other 3 lacked relevant history or documented inducible ischemia. The OCT images of all lesions were consistent with recanalization of organized thrombi, which consisted of septa that divided the lumen into multiple small cavities communicating with each other with significant stenosis. These structures had smooth inner borders with traces of intraluminal thrombi, but no separate 3-layered structure could be defined. Drug eluting stents were successfully implanted in all braid-like lesions. All patients were event free for 12 months, and 3 patients received control CAGs which showed stents patent. Conclusions Most cases of braid-like coronary artery may be recanalization of organized thrombi rather than Woven Coronary Artery. Smoking may be a potential risk factor. Percutaneous stent implantation may be challenging but benificial in selected patients. The underlying cause of the forming of such thrombotic lesions remained unclear. Imagings before and after intervention Funding Acknowledgement Type of funding source: None