Woven Koroner Arter Anomalisi: Tanı, Ayırıcı Tanı ve Klinik Yönetim
Özet
Otuz dört yaşında erkek hasta, atipik göğüs ağrısı, elektrokardiyografi (EKG) değişiklikleri ve yüksek duyarlılıklı kardiyak troponin yüksekliği nedeniyle ST yükselmesiz miyokard enfarktüsü (NSTEMI) ön tanısıyla değerlendirildi. Koroner anjiyografide sol ön inen arterin orta segmentinde çoklu ince kanallara ayrılıp distal segmentte yeniden birleşen, woven koroner arter anomalisi ile uyumlu görünüm izlendi. Distal Thrombolysis in Myocardial Infarction (TIMI) 3 akımın korunması, hastanın hemodinamik olarak stabil seyretmesi ve devam eden iskemi bulgusunun izlenmemesi nedeniyle konservatif medikal tedavi tercih edildi. Bu olgu, woven koroner arter anomalisi ile spontan koroner arter diseksiyonu, rekanalize trombüs ve kompleks aterosklerotik lezyon ayrımının klinik yönetim açısından önemini vurgulamaktadır.
A 34-year-old male patient was evaluated with a preliminary diagnosis of non-ST-segment elevation myocardial infarction (NSTEMI) because of atypical chest pain, electrocardiographic changes, and elevated high-sensitivity cardiac troponin. Coronary angiography revealed a characteristic appearance compatible with a woven coronary artery anomaly in the mid segment of the left anterior descending artery, consisting of multiple thin channels that separated and then rejoined distally. Because distal Thrombolysis in Myocardial Infarction (TIMI) grade 3 flow was preserved, the patient remained hemodynamically stable, and there was no evidence of ongoing ischemia, conservative medical treatment was preferred. This case highlights the clinical importance of distinguishing woven coronary artery anomaly from spontaneous coronary artery dissection, recanalized thrombus, and complex atherosclerotic lesions, as this distinction may directly affect management.
Referanslar
Sane DC, Vidaillet HJ Jr. “Woven” right coronary artery: a previously undescribed congenital anomaly. Am J Cardiol. 1988;61(13):1158. doi:10.1016/0002-9149(88)90159-2
Joseph SC, D’Antoni AV, Tubbs RS, Gielecki J, Loukas M. Woven coronary arteries: a detailed review. Clin Anat. 2016;29(4):502-507. doi:10.1002/ca.22657
Val-Bernal JF, Malaxetxebarria S, González-Rodilla I, Salas-García M. Woven coronary artery anomaly presenting as sudden cardiac death. Cardiovasc Pathol. 2017;26:7-11. doi:10.1016/j.carpath.2016.10.002
Kaya D, Kilit C, Onrat E. An uncommon congenital anomaly of coronary arteries misdiagnosed as intracoronary thrombus: woven coronary artery disease. Anatol J Cardiol. 2006;6(4):383-384.
Güner A, Alizade E, Tanık VO, Püşüroğlu H, Karaüzüm K, Varım P, ve ark. Percutaneous Coronary Intervention or Optimal Medical Therapy for Woven Coronary Anomaly (The Multicenter EVOLUTE-WOVEN Study). Am J Cardiol. 2026;268:87-95. doi:10.1016/j.amjcard.2026.03.038
Cito S, Puri R, Pallarès J, Abdul-Jawad Altisent O, Bayes-Genis A. Woven coronary disease: friend or foe? Circ Cardiovasc Interv. 2019;12(9):e008087. doi:10.1161/CIRCINTERVENTIONS.119.008087
Tasal A, Bacaksiz A, Erdogan E, Küçükdurmaz Z. Successful percutaneous management of occluded “woven” coronary artery: a case report. Postepy Kardiol Interwencyjnej. 2012;8(2):168-172. doi:10.5114/pwki.2012.29660
Martuscelli E, Romeo F, Giovannini M, Nigri A. Woven coronary artery: differential diagnosis with diffuse intracoronary thrombosis. Ital Heart J. 2000;1(4):306-307.
Guo Y, Han P, Geng X, Zhu H, Zhang F. Optical coherence tomography-assisted diagnosis and optimal treatment of three patients with woven coronary artery. Cureus. 2025;17(3):e80648. doi:10.7759/cureus.80648
Liu J, Hau WK, Li Y, Huang X. Application of a hybrid IVUS-OCT imaging system in woven-like coronary arteries. JACC Case Rep. 2025;30(38):105785. doi:10.1016/j.jaccas.2025.105785
Gao X, Liu B, Li X, Ma S, Su G, Li Z. Honeycomb-like structure (HLS) in the left anterior-descending coronary artery-recanalized thrombus demonstrated by intravascular ultrasound (IVUS) in a patient with polycythemia vera and thrombocythemia. Herz. 2023;48(6):470-473. doi:10.1007/s00059-023-05193-3
Kursaklioglu H, Iyisoy A, Celik T. Woven coronary artery: a case report and review of literature. Int J Cardiol. 2006;113(1):121-123. doi:10.1016/j.ijcard.2005.08.019
Yıldırım A, Oğuz D, Olguntürk R. Woven right and aneurysmatic left coronary artery associated with Kawasaki disease in a 9-month-old patient. Cardiol Young. 2010;20(3):342-344. doi:10.1017/S1047951110000223
Bozkurt A, Akkus O, Demir S, Kaypakli O, Demirtas M. A new diagnostic method for woven coronary artery: optical coherence tomography. Herz. 2013;38(4):435-438. doi:10.1007/s00059-012-3722-x
Soylu K, Meric M, Zengin H, Yüksel S, Kaya MG. Woven right coronary artery. J Card Surg. 2012;27(3):345-346. doi:10.1111/j.1540-8191.2012.01453.x
