4/1/2023 0 Comments Concertina accordion4 In the literature, there are reported cases of coronary CP mimicking coronary dissection. If the interventional cardiologist cannot recognize the CP, it may cause unnecessary further percutaneous coronary interventions to an otherwise normal coronary segment. The differential diagnosis plays a major role in patient management during the CP. The CP effect usually has no major clinical sequelae and does not usually require any special interventions however, it may cause hemodynamic compromise and ischemia. 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. 2 The traditional risk factors associated with coronary spasms such as cigarette smoking and hypertension are also related to this phenomenon. 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. 1 The CP is usually seen as a result of the straightening of the tortuous segment of a coronary artery. The CP is described as the occurrence of new lesions or stenoses after the placement of a stiff guide wire in a tortuous artery. After the intervention, the patient remained in very good clinical status and was discharged on the third postprocedural day. A 3.0 × 16 mm PROMUS Element Stent (Boston Scientific, Natick, MA, USA) was deployed at 14 atm in order to prevent ischemic arrhythmias ( Figure 1D). The pseudolesions disappeared after the choice floppy guide wire was placed in the mid LAD ( Figure 1C). The choice floppy guide wire was withdrawn since the proximal critical lesion was lost in the angiographic images secondary to the accordion effect. The pseudolesions were refractory to the intracoronary nitroglycerine injection. Interestingly, the LAD did not have a high tortuous course. The disappearance of the true lesion was considered to be secondary to the CP ( Figure 1B). The wiring was followed by the occurrence of pseudolesions (the concertina effect) at the mid and distal segments of the LAD and the disappearance of the proximal LAD lesion. A choice floppy guide wire (Boston Scientific, Natick, MA, USA) was used, and its 3-cm radiopaque tip was placed in the distal part of the LAD. Before wiring, intracoronary nitroglycerine was used in order to exclude vasospasm. Following the decision, a 6-F Judkins left guiding catheter was passed through the femoral artery to the ostium of the left main coronary artery. Therefore, a decision was made to perform a percutaneous coronary intervention on the proximal portion of the LAD. The results showed a critical stenosis in the proximal LAD ( Figure 1A). Hence, coronary angiography was scheduled and performed via the femoral artery using a 6-F Judkins left diagnostic catheter. The exercise stress test yielded a Duke treadmill score of -12. Transthoracic echocardiography demonstrated a normal left ventricular systolic function, mild mitral regurgitation, and grade 1 diastolic dysfunction. On physical examination, auscultation of the chest showed no murmurs or pathologic sounds and the other systems were normal. The blood pressure of the patient was 130/80 mm Hg. Electrocardiography revealed a normal sinus rhythm without ischemic findings. On medical history, the patient was diagnosed with hypertension 2 years previously and was prescribed a valsartan–amlodipine combination. A 53-year-old male patient presented to our cardiology department with a retrosternal chest pain of 2 months’ duration.
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