Reviews in DepthCoronary artery tortuosity a narrative reviewKahe, Farima; Sharfaei, Sadaf; Pitliya, Anmol; Jafarizade, Mehrian; Seifirad, Soroush; Habibi, Shaghayegh; Chi, GeraldAuthor Information Department of Medicine, Division of Cardiovascular Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, USA Correspondence to Gerald Chi, MD, Department of Medicine, Division of Cardiovascular Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, 930 Commonwealth Avenue #3, Boston, MA 02215, USA Tel: +1 617 975 9952; fax: +1 617 975 9955; e-mail: email@example.com Coronary Artery Disease: March 2020 - Volume 31 - Issue 2 - p 187-192 doi: 10.1097/MCA.0000000000000769 Buy Metrics Abstract Coronary artery tortuosity (CAT) is a prevalent angiographic finding commonly associated with aging, hypertension, atherosclerosis and other conditions. Preliminary evidence suggests that degradation of elastin, a key component of extracellular matrix in the vascular wall, may be responsible for the development of CAT. The clinical significance of CAT should be considered in several aspects. First, coronary flow alteration associated with CAT may result in myocardial ischemia owing to reduced perfusion pressure distal to the tortuous segment. Second, increased and oscillatory shear stress in the tortuous vessel may promote atherosclerotic plaque formation and acute coronary syndrome. Third, as one of the criteria for coronary lesion complexity, the presence of severe tortuosity proximal to the culprit lesion may pose a challenge to wiring and stent or balloon delivery, thereby increasing the risk of periprocedural complications. Last, the presence of CAT may serve as a diagnostic clue of concurrent vasculopathy such as fibromuscular dysplasia or spontaneous coronary artery dissection. In general, CAT represents a benign entity that does not require specific treatment or intervention. Further research is warranted to elucidate the pathogenesis and prognostic effect of coronary tortuosity. Copyright © 2020 Wolters Kluwer Health, Inc. All rights reserved.