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
The patient described atypical exertional chest pain, with no prior cardiovascular risk factors.
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.
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.
The authors used intravascular ultrasound to demonstrate a normal calibre of coronary artery. An alternative modality of optical coherence tomography may be used.
The above approach identified a false positive finding of possible coronary stenosis, which when ruled out prevented inappropriate treatment with a coronary artery stent.
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.
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.