Abstract / Summary
Abstract Background Woven coronary artery (WCA) is a rare coronary anomaly featuring multiple tortuous channels forming a distinctive “woven” pattern. Its pathogenesis and optimal management remain uncertain. This article retrospectively analyzes the angiographic characteristics, clinical features, and treatment strategies of WCA to provide a reference for its clinical management. Methods This retrospective cohort study enrolled 26 patients with 28 woven coronary arteries (WCAs) to investigate the clinical manifestations, angiographic features, treatment strategies, and prognosis. According to the treatment strategy, WCAs were categorized into an interventional group (12 WCAs) and a medical therapy group (16 WCAs). Intravascular imaging, including optical coherence tomography (OCT) or intravascular ultrasound (IVUS), was performed at the operator’s discretion. The primary endpoints were major adverse cardiovascular events (MACE) and target vessel failure (TVF), with a mean follow-up duration of 25.8 months. Results WCA was more prevalent in males (88.5%). The most frequently involved vessel was the right coronary artery (RCA) (57.1%), followed by the left anterior descending artery (LAD) (35.7%), and the left circumflex artery (LCX) was the least commonly affected (3.6%). Moreover, multivessel coronary artery disease was present in 20 patients (76.9%). Distal flow was graded as Thrombolysis in Myocardial Infarction (TIMI) grade 3 in the majority of WCAs (82.1%). Percutaneous coronary intervention (PCI) procedures were associated with a higher rate of periprocedural complications, including slow flow, no-reflow, and side branch occlusion. OCT/IVUS demonstrated features consistent with recanalized or organized thrombus in 14 of 28 WCAs (50.0%). During follow-up, none of the medically managed WCAs required revascularization. Conclusions This study proposes a novel vascular formation hypothesis termed “thrombus recanalization-ant nest remodeling”, suggesting that thrombus recanalization may represent one of the pathogenic mechanisms underlying WCA. Treatment modalities can be selected based on individual ischemic risk assessment. PCI may be considered in selected lesions, but its technical complexity and risk of periprocedural complications require careful individualized risk-benefit assessment.