Published online Dec 26, 2017. doi: 10.4330/wjc.v9.i12.838
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
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.
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.