Mustafa Adem TATLISU, Adnan KAYA, Dilaver ÖZ, Mehmet EREN

Accordion effect in right coronary artery mimicking dissection

Akordiyon veya konçertina etkisi tortiyoze arterlerin bir psödolezyonu olup, yalancı diseksiyon,spazm, trombüs ve emboli görünümü ile karışabilir ve girişim sırasında sert kılavuz tellerledamarların kısaltılıp doğrultulması nedeniyle işlemcide büyük bir endişe uyandırır. Bu makaledeST segment elevasyonlu myokard infarktüsü olup; sağ koroner arterin proximal segmentindeakordiyon etkisi bulunan 51 yaşında bir olgu sunulmuştur. Klinik uygulamada perkütantransluminal koroner anjioplasti esnasında koroner arter disseksiyonu görülmesi yaygındır.Bu vakakonçertina etkisi ile ilgili kısa bir bildiridir. Girişimsel kardiyologların koroner girişimler sırasındakonçertina etkisini akıllarında bulundurmaları gerekmektedir.

Sağ koroner arterde diseksiyonu taklit eden akordiyon efekti

Accordion or concertina effect is defined as a pseudolesion of tortuous arteries which confusedwith false dissection, spasm, thrombus and embolus appearence and that gives great concerns tothe operator occurs due to straightening and shortening of the vessels with stiff guide wires duringthe intervention. We present a case of accordion effect in proximal segment of right coronaryartery in 51-year-old patient with ST-segment elevation myocardial infarction. Coronary arterydissection during percutaneous transluminal coronary angioplasty is commonly seen in clinicalpractice. This case is a brief report on concertina effect. We must keep in mind concertina effectbefore proceeding with a coronary intervention as an interventional cardiologist.

PDF

___

1. Grewe K, Presti CF, Perez JA. Torsion of an internal mammary graft during percutaneous transluminal coronary angioplasty: a case report. Cathet Cardiovasc Diagn 1990; 19: 195-7.
2. Deligonul U, Tatineni S, Johnson R, Kern MJ. Accordion right coronary artery: An unusual complication of PTCA guidewire entrapment. Cathet Cardiovasc Diagn 1991; 23: 111-3.
3. Rauh RA, Ninneman RW, Joseph D, Gupta VK, Senior DG, Miller WP. Accordion effect in tortuous right coronary arteries during percutaneous transluminal coronary angioplasty. Cathet Cardiovasc Diagn 1991; 23: 107- 10.
4. Doshi S, Shiu MF. Coronary Pseudolesions induced in the left anterior descending and right coronary artery by the angioplasty guidewire. Int J Cardiol 1999; 68: 337-42.
5. Blankenship JC. Right coronary artery pseudotransection due to mechanical straightening during coronary angioplasty. Cathet Cardiovasc Diagn 1995; 36: 43-5.
6. Hays JT, Stein B, Raizner AE. The crumpled coronary: an enigma of arteriographic pseudopathology and its potential for misinterpretation. Cathet Cardiovasc Diagn 1994; 31: 293- 300.
7. Alvarez JA, Leiva G, Manavella B, Cosentino JJ. Left main crumpling during left anterior descending angioplasty: Hitherto unreported location for the accordion effect. Catheter Cardiovasc Interv 2001; 52: 363-7.
8. Tsutsumi M, Kazekawa K, Onizuka M, Aikawa H, Iko M, Kodama T, Nii K, Matsubara S, Etou H, Tanaka A. Accordion effect during carotid artery stenting: report of two cases and review of the literature. Neuroradiology 2007; 49: 567-70.
9. Dawson DL, Hellinger JC, Terramani TT, Najibi S, Martin LG, Lumsden LB. Iliac Artery Kinking with Endovascular Therapies: Technical Considerations. J Vasc Interv Radiol 2002; 13: 729-33.
10. Chalet Y, Chevalier B, El Hadad S, Guyon P, Lancelin B. Pseudo narrowingduring right coronary angioplasty: how to diagnose correctly without withdrawing the guidewire. Cathet Cardiovasc Diagn 1994; 31: 37-40.
11. Goel PK, Agarwal A, Kapoor A. Concertina Effect during Angioplasty of Tortuous Right and Left Coronary Arteries and Importance of Using Over-the- Wire System: A Case Report. Indian Heart J 2001; 53: 87-90.