Accordion right coronary artery: An unusual complication of ptca guidewire entrapment

Abstract

The contour of the epicardial coronary vessels may change considerably during coronary angioplasty. We report the extreme and unique "accordion-like" wrinkling of the mid right coronary artery as a result of distal guidewire entrapment during coronary angioplasty. Recognition of this artifact and its treatment may prevent further complications of coronary angioplasty.

Mechanical coronary artery shortening with vessel wall deformity during directional coronary atherectomy: First reported case involving the left anterior descending artery

“…Others have reported decrease in flow through the affected vessel confirming that this phenomenon can be hemodynamically significant [2,5]. Therefore, the effects on flow patterns cannot be used to distinguish the etiology of the stenosis.…”

“…deformity consistent with invagination and the second resulted in a concentric defect, presumably from circumferential shortening and hence the ''accordion effect" as it was described. In an even more dramatic case, Deligonul et al [5] reported "the accordion effect" when a guidewire tip was incarcerated in a distal small branch of the right coronary artery. When the dilating catheter was withdrawn, traction on the guidewire resulted in severe vessel wall shortening and consequent "wrinkling" of the vessel and the angiographic appearance of a "corkscrew-like irregularity. "…”

Accordion effect in right coronary artery mimicking dissection

“…Concertina in other words accordion effect is a pseudocomplication of PCI that mimics above cited real complications. The basic mechanism for the appearance of these pseudolesions is the straightening of a tortuous coronary artery along its luminal axis by relatively stiff intracoronary equipment, usually the guide wire, running down its length 2,[4][5][6] . Straightening the tortuous vessels with stiff guide wires makes it easy to pass the lesion with balloon and to dispose the stent.…”

“…Concertina or accordion effect is an appearance of artifactual or pseudolesions during the course of PCI in tortuous vessels 1,2,3 . The possible mechanism suggested for accordion effect is straightening and shortening of tortuous artery by the stiff wire ended with invagination which showed up as a ''stair step deformity'' with contrast dye.…”

Equipment-dependent mechanical distortion of a tortuous right coronary artery during PTCA

“…Also, the RCA Mechanical straightening of a tortuous vessel during percutaneous transluminal coronary angioplasty (PTCA) has been well described [1,2]. This straightening has been termed an "accordion effect."…”