Woven coronary artery anomaly

Abstract

Objective: To critically analyze the available literature on woven coronary artery anomaly, emphasizing its clinical, diagnostic, pathophysiological, and therapeutic aspects, as well as existing gaps in knowledge. Literature review: Woven coronary artery anomaly is a rare condition characterized by the division of a segment of the coronary artery into multiple thin channels that rejoin distally, usually with preserved flow according to the Thrombolysis in Myocardial Infarction (TIMI) classification. The review demonstrated a predominance of male patients, with the right coronary artery being the most frequently affected vessel. Clinical manifestations ranged from incidental findings in asymptomatic patients to angina, acute coronary syndrome, acute myocardial infarction, and isolated reports of sudden cardiac death. Coronary angiography was the main diagnostic method, while intravascular ultrasound and optical coherence tomography were essential for diagnostic confirmation and for differentiation from acquired entities. Therapeutic strategies included clinical follow-up, medical therapy, and, in selected cases, percutaneous coronary intervention or coronary artery bypass surgery, with predominantly favorable outcomes when reported. Final   considerations: Woven coronary artery anomaly should not be universally considered benign, requiring careful diagnostic assessment and individualized therapeutic decision-making; however, the scarcity of robust studies limits the establishment of specific clinical guidelines.