Vessel wall shortening and deformity due to "arterial telescoping" is a not infrequent reversible phenomenon that occurs during coronary angioplasty and is associated with the advancement of a stiff wire through elongated and tortuous segments, with straightening of the artery and deep guiding catheter introduction beyond the coronary ostium. We present the first described case of the accordion effect involving the left main coronary artery. On detecting arterial crumpling, it is essential to make a differential diagnosis between the accordion syndrome and PTCA potential complications (spasm, thrombosis and dissection), to avoid further therapeutic intervention.
The "accordion effect" is a mechanical remodeling of the arterial wall produced by endoluminal introduction of stiff guidewires, leading to vessel wall shortening and development of multiple eccentric constrictions. This phenomenon is unresponsive to vasodilators and may lead to unnecessary stenting of the pseudo-lesions. It must be suspected with the development of multiple lesions and when a tortuous artery assumes a linear shape after advancing distally a stiff wire. In the situation of a complete occlusion of the artery the diagnosis may be challenging. Stenting in this scenario can be demanding because of the difficulty to appropriately size the length of the stent to the true lesion. We present a case of an unrecognized accordion phenomenon in an occluded coronary artery with a long dissection treated with two stents that after retrieving the wire were insufficient to cover the whole dissection.
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