Case Report
Copyright ©The Author(s) 2017. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Cardiol. Dec 26, 2017; 9(12): 838-841
Published online Dec 26, 2017. doi: 10.4330/wjc.v9.i12.838
Artefactual angulated lesion on angiography: A case report and review of literature
Sadat Ali Edroos, Jeremy William Sayer
Sadat Ali Edroos, Jeremy William Sayer, Department of Cardiology, the Essex Cardiothoracic Centre, Basildon ESSEX SS16, United Kingdom
Author contributions: Edroos SA and Sayer JW performed the case, reviewed the literature, wrote and edited the manuscript.
Informed consent statement: All patients identifiable information has been anonymised in this case report. The patient provided informed verbal consent for their case to be written up.
Conflict-of-interest statement: The authors declare that there is no conflict of interest.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Correspondence to: Sadat Ali Edroos, BSc, MBChB, PhD, MRCP, Cardiology Registrar, Department of Cardiology, the Essex Cardiothoracic Centre, Nethermayne, Basildon ESSEX SS16 5NL, United Kingdom. sadat.edroos@nhs.net
Telephone: +44-1268-394173 Fax: +44-1268-394179
Received: September 20, 2017
Peer-review started: September 21, 2017
First decision: October 23, 2017
Revised: November 20, 2017
Accepted: December 3, 2017
Article in press: December 3, 2017
Published online: December 26, 2017
Processing time: 92 Days and 11.2 Hours
Abstract

We present a case of a patient who presented with chest pain, and on diagnostic coronary angiography appeared to have a grossly angulated yet significant coronary stenosis. This was proven to be an artefactual appearance on further assessment with intravascular ultrasound imaging. We describe the causes and associations of coronary tortuosity with other arteriopathy, and highlight challenges in the interpretation of tortuous vessels to accurately assess luminal narrowing and suitability for coronary intervention. We describe a case of artefactual coronary stenosis, and its thorough assessment with intravascular ultrasound. A literature review describes the pathogenesis of coronary tortuosity, and links with other cardiovascular disease. Readers will gain an understanding of the challenge in determining the severity of luminal stenosis based on coronary angiography alone in tortuous coronary anatomy, the use of intravascular ultrasound in this setting, and the allied vasculopathies of interest.

Keywords: Coronary tortuosity; Intravascular ultrasound; Spontaneous coronary artery dissection; Diagnostic coronary angiography

Core tip: Coronary arteries are inherently tortuous, and are assessed at angiography, compressing a 3D structure into a 2D picture. An overly tortuous artery may resemble true luminal stenosis, rather than mere angulation, and may be interpreted as a significant coronary stenosis. We present a remarkably angulated coronary artery, which appeared to bear a significant stenosis. On further assessment with pressure wire study and intravascular ultrasound we found there to be no significant lesion. We demonstrate an artefactual false-positive finding, and describe our clinical approach to avoid mistaking such a lesion for one that requires intervention, with a review of the literature.