Optical coherence tomography and fractional flow reserve guided treatment of woven coronary artery anomaly presenting as acute myocardial infarction: A case report

RATIONALE: Woven coronary artery is a very rare congenital anomaly which may lead to acute coronary syndrome in previous literatures. At present, there is no consensus on the treatment of this coronary artery abnormality. PATIENT CONCERNS: A 48-year-old male was admitted to the other hospital because of persistent chest pain. The electrocardiogram showed an ST-segment elevation in the v1-v5 lead and the patient was diagnosed with acute anterior myocardial infarction. Coronary angiography revealed 2 lumens in the proximal segment of the left anterior descending artery. Then the patient was transferred to our hospital for further diagnosis and treatment. DIAGNOSES: The patient was diagnosed with acute myocardial infarction and woven coronary. Transthoracic echocardiography showed left ventricular anterior wall segmental motor abnormalities. INTERVENTIONS: Optical coherence tomography (OCT) and fractional flow reserve (FFR) guided percutaneous coronary intervention was performed successfully. OUTCOMES: During the follow-up period of 4 years, the patient remained asymptomatic and no adverse events. LESSONS: Although the significance of blood flow limitation in one of the lumens detected by FFR is unclear, this strategy of OCT and FFR-guided treatment in woven coronary artery combined with acute coronary events still shows its feasibility.