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Coronary accordion effect mimicking coronary dissection

A 52-year-old female patient underwent coronary angiography (CAG) due to unstable angina pectoris. Her left coronary system was normal and a critical lesion was observed in the mid portion of the highly tortuous right coronary artery (RCA) (Figure 1). After straightening the RCA with two floppy guidewires and a balloon catheter system (Figure 2), a 2.75 mm × 18 mm sirolimus-eluting stent was implanted in the mid RCA (Figure 3). After stent implantation, CAG revealed haziness, extreme coronary kinking and wrinkles in the proximal portion of the RCA (Figures 4A and B). After extraction of guidewires, all of the kinking, wrinkles and haziness disappeared (Figure 5). The procedure was terminated.

The coronary “accordion” effect is a rare pseudo-complication of percutaneous coronary intervention (PCI) [1]. It is usually observed due to straightening and shortening of tortuous vessels with stiff guidewires during PCI. 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. No specific treatment is needed and it usually resolves spontaneously after extraction of guidewires.

References

 1. Ciszewski A, Malecka L, Cedro K. Objaw akordeonowy. Rzadkie pseudopowikłanie angioplastyki wieńcowej [Polish]. Kardiol Pol 2004; 60: 60–62.

 2. Gouveia D, Escudero J, Domingo E, et al. De-novo reversible stenoses in tortuous arteries during coronary angioplasty due to the accordion effect. A clinical case and review of the literature. Rev Port Cardiol 1997; 16: 1037–1042, 1957.

 3. Yasuoka Y, Morisawa D, Kitada H, et al. An accordion phenomenon with ST-segment elevation of electrocardiogram and anginal chest pain: a case report. Int J Cardiol 2009; 135: e62–e64.

 4. Gavrielatos G, Pappas LK, Anthopoulos P, et al. Severe accordion effect: myocardial ischemia due to wire complication during percutaneous coronary intervention: a case report. Cases J 2008; 1: 138.