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
ARTICLE HIGHLIGHTS
Case characteristics

The patient described atypical exertional chest pain, with no prior cardiovascular risk factors.

Clinical diagnosis

Coronary angiography initially appeared to demonstrate a severe lesion in the proximal left anterior descending coronary artery, which was demonstrated to be a false positive finding in an angulated artery with no significant coronary stenosis, through further physiological and anatomical testing.

Differential diagnosis

Further assessment of a lesion of this nature may be carried out using functional assessment, with a pressure wire study, or anatomical assessment, with intravascular ultrasound, as demonstrated here.

Imaging diagnosis

The authors used intravascular ultrasound to demonstrate a normal calibre of coronary artery. An alternative modality of optical coherence tomography may be used.

Treatment

The above approach identified a false positive finding of possible coronary stenosis, which when ruled out prevented inappropriate treatment with a coronary artery stent.

Related reports

The authors describe the aetiology of coronary angulation, which may be degenerative or heritable, and though epicardial tortuosity has not been shown to be associated with an increase in major adverse cardiovascular events an association with spontaneous coronary artery dissection, and the potential for misinterpretation of angulation as luminal stenosis, are important considerations when assessing lesions.

Experiences and lessons

The authors learned the importance of multimodality assessment of apparent coronary lesions to justify, and subsequently rule out, the need for intervention in a case of marked coronary artery curvature, and present an approach to prevent mis-interpretation.