Left main crumpling during left anterior descending angioplasty: Hitherto unreported location for the “accordion effect”

Abstract

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.

Accordion effect in right coronary artery mimicking dissection

“…It has also been described in left main coronary artery angioplasty 7 , carotid artery angioplasty 8 and iliac artery angioplasty 9 . The incidence of concertina is about 0.4% 3 .…”

Accordion Phenomenon in the Radial Artery : Should we Treat the Radial as a Coronary Artery ? = ظاهرة الأكورديون في الشريان الكعبري : هل ينبغي لنا معالجة الشريان الكعبري بمثابة الشريان التاجي ؟

“…5 The differential diagnosis for this benign condition includes more serious conditions like dissection, spasm and thrombosis. 6 Three major factors contributed to this phenomenon: tortuosity of the artery, the use of a stiff guidewire, and long stenting. 7 It has been also described with a soft guidewire.…”

Severe accordion effect: Myocardial ischemia due to wire complication during percutaneous coronary intervention: A case report

“…Appearance of the accordion phenomenon, during routine angioplasty procedure, is not uncommon and is produced by mechanical alteration of the geometry and the curvature of the vessel due to straightening effect and shortening of the artery, preceded from guidewire or catheter balloon manipulation [ 1 ]. The highest incidence of accordion effect is seen when highly tortuous arterial vessels are linearized with a stiff guidewire and it can be simply be reversed by the withdrawn of the mechanical device causing the artery deformation [ 2 ].…”

“…The accordion phenomenon has been primarily reported in the era of PCI [ 1 , 3 ]. The right coronary artery is thought to be predominantly prone to this phenomenon because the artery is entrenched in the epicardial fat tissue and courses rather freely in the atrioventricular groove.…”