Pseudo dislodgement of a stent due to crumpling of a coronary artery: A hitherto unreported complication of the “accordion effect”

Abstract

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.

Functional assessment of coronary artery disease by intravascular ultrasound and computational fluid dynamics simulation

“…The correlation they found between the two methods was 0.72 (p<0.05), improving the diagnostic accuracy of coronary CTA to predict functionally significant lesions of 50---80%. 10 In conclusion, we believe that the use of 3D IVUS reconstruction associated with CFD can improve the diagnostic accuracy of IVUS for the functional assessment of coronary lesions. 9 However, although the correlation between the results obtained from CFD and invasive angiography is good, the technique has limitations.…”

Newly developed lesions in right coronary artery during PCI

“…Answer is 4. The accordion effect is seen when tortuous vessel is straightened with an extra-support guidewire (1,2). The diagnosis of the accordion effect is made by pulling the causative device completely out.…”