Optical coherence tomography-assisted interventional treatment of a woven coronary artery: a case report

BACKGROUND: A woven coronary artery is a rare feature on coronary angiography. Distinguishing woven-like change and recanalization of an occluded artery is difficult. CASE PRESENTATION: A 59-year-old man was admitted to the hospital for chest tightness. Coronary angiography showed a woven coronary artery at the middle segment of the left anterior descending branch (LAD). The middle segment of the right coronary artery (RCA) exhibited 99% occlusion. A 3.5 × 26-mm drug-eluting stent was implanted in the middle segment of the RCA. One week later, we examined the LAD using optical coherence tomography (OCT). Considering the patient’s medical history and the results of OCT, a 2.7 × 38-mm drug-eluting stent was inserted into the LAD. Re-examination by OCT indicated that the stent was well attached to the wall, with no dissection at the edge of the stent. Antiplatelet therapy and statin-based plaque stabilization were continued. No obvious abnormality was found during follow-up one year later. CONCLUSIONS: OCT can help distinguish woven-like change and recanalization of an occluded coronary artery. The evaluation and formulation of treatment strategies for a woven coronary artery are important.