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

Abstract

A mechanical alteration during manoeuvring of stiff guidewires in tortuous coronary arteries frequently induces vessel wall shortening and coronary psedostenosis, referred as accordion phenomenon. Subtraction of the guidewires normally leads to the entire resolution of the lesions. A case of this transient angiographic finding, during percutaneous coronary intervention in a tortuous right coronary artery, which resulted in a flow limiting effect and myocardial ischemia, is described in the present report. Differential diagnosis from potential procedure complications and interventional methodology issues are discussed, while similar reports are reviewed.

s Coronary accordion effect mimicking coronary dissection

“…Mechanical shortening and vessel wall invagination are the suspected mechanisms [ 2 ]. It may cause severe ischemia and even myocardial infarction [ 3 , 4 ]. It is important to differentiate it from dissection and spasm.…”

Concertina Phenomenon in the Left Anterior Descending Artery: An Unexpected Circumstance in an Unexpected Vessel

“…The right coronary artery is the most commonly affected coronary artery as it is located in the epicardial fat tissue and courses rather freely in the atrioventricular groove. 2 The traditional risk factors associated with coronary spasms such as cigarette smoking and hypertension are also related to this phenomenon. 3 The 2 most important risk factors for the occurrence of this phenomenon are an increased tortuosity of the vessel and the use of stiff interventional guide wires.…”

Well-described concertina effect during coronary angioplasty

“…The RCA is generally prone to this effect because it is entrenched in the epicardial fat tissue and courses rather freely in the atrioventricular groove. 1 The concertina effect can be mistaken for dissection or coronary spasm, which may result in unnecessary complex procedures, changing a completely reversible condition into an iatrogenic complication. Concertina effects are usually benign and do not require special intervention.…”