Optical Coherence Tomography-Assisted Diagnosis and Optimal Treatment of Three Patients With Woven Coronary Artery

Woven coronary artery (WCA) is an infrequent coronary artery anomaly characterized by the segmentation of one or more coronary artery portions into multiple small channels by intertwining small blood vessels, which reconverge into a normal lumen in the distal segment. Coronary angiography is not sufficiently accurate for the definitive diagnosis of "braid-like lesions." Optical coherence tomography (OCT) examination provides a clearer understanding of the coronary artery conditions. We reported on three cases that exhibited manifestations similar to Woven syndrome during coronary angiography. After OCT examination, in one of the cases, there was a presence of thrombus and cavities of varying sizes in the coronary artery, with intercommunication between the cavities and no apparent tunica media, suggesting organized thrombus. The patient underwent stent implantation treatment. The other two cases were confirmed to have relatively intact three-layer vascular structures within each channel and a significant absence of important coronary atherosclerotic disease upon OCT examination, leading to a diagnosis of Woven syndrome. They were then treated with optimal medical therapy. In the context of coronary angiography, woven coronary artery (WCA) presents as "honeycomb," "braid-like," and "figure 8" configurations, often mimicking spontaneous coronary dissection or recanalized thrombus. Optical coherence tomography (OCT) emerges as an indispensable diagnostic adjunct, providing confirmatory evidence and mitigating the risk of procedural complications associated with misdiagnosis and facilitating the selection of therapeutic strategies. This report discusses the differential diagnosis, diagnostic challenges, and treatment considerations for WCA.