Jhawar Nikita, Gharacholou Shahyar Michael
Department of Cardiovascular Disease, Cooper University Hospital, Camden, NJ, USA.
Department of Cardiovascular Medicine, Mayo Clinic, Jacksonville, FL, USA.
Future Cardiol. 2025 Jun;21(8):621-627. doi: 10.1080/14796678.2025.2511428. Epub 2025 May 30.
Coronary kinking represents an underrecognized diagnosis which typically arises as a complication of invasive cardiovascular procedures but may also be non-iatrogenic and nonatheromatous. Determining the etiology of coronary kinking poses a diagnostic dilemma with limited guidance in the medical literature. A stenotic lesion on invasive coronary angiography (ICA) may be attributable to intrinsic causes, such as atherosclerosis, fibromuscular dysplasia, coronary vasospasm, spontaneous coronary artery dissection, coronary kinks, and severe tortuosity, or extrinsic causes such as myocardial bridging. Lesions that appear angiographically atypical can be further elucidated with intracoronary imaging using intravascular ultrasound (IVUS) or optical coherence tomography (OCT), which help distinguish coronary kinks from other mimicking etiologies. Coronary kinks have the potential to cause ischemia, arrhythmia, and other structural complications, underscoring the importance of early and accurate detection. In this review, we summarize and appraise published data on coronary kinks. We also share a diagnostic schema on how to investigate coronary kinks with noninvasive and invasive techniques.
冠状动脉扭曲是一种未被充分认识的诊断，通常作为侵入性心血管手术的并发症出现，但也可能是非医源性和非动脉粥样硬化性的。确定冠状动脉扭曲的病因构成了一个诊断难题，医学文献中的指导有限。侵入性冠状动脉造影（ICA）上的狭窄病变可能归因于内在原因，如动脉粥样硬化、纤维肌发育不良、冠状动脉痉挛、自发性冠状动脉夹层、冠状动脉扭曲和严重迂曲，或外在原因，如心肌桥。血管造影表现不典型的病变可以通过血管内超声（IVUS）或光学相干断层扫描（OCT）等冠状动脉内成像进一步阐明，这有助于将冠状动脉扭曲与其他类似病因区分开来。冠状动脉扭曲有可能导致缺血、心律失常和其他结构并发症，凸显了早期准确检测的重要性。在本综述中，我们总结并评估了关于冠状动脉扭曲的已发表数据。我们还分享了一个关于如何使用非侵入性和侵入性技术研究冠状动脉扭曲的诊断方案。
