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A case of accordion phenomenon accompanied by severe transmural myocardial ischemia

Naotsugu Oyama1, Kazushi Urasawa, Hidetsugu Sakai

  • 1Department of Cardiovascular Medicine, Hokkaido University Graduate School of Medicine, Sapporo, Japan.

Japanese Heart Journal
|June 4, 2002
PubMed

Insights

A rare case of severe myocardial ischemia occurred after percutaneous coronary intervention in a tortuous right coronary artery. Straightening the artery caused the accordion phenomenon, leading to slow blood flow and chest pain.

Area of Science:

  • Cardiology
  • Interventional Cardiology
  • Vascular Biology

Background:

  • Percutaneous coronary intervention (PCI) is a common procedure for treating coronary artery disease.
  • Severely tortuous coronary arteries present unique challenges during PCI.
  • The accordion phenomenon is a rare complication that can occur during vascular interventions.

Observation:

  • A patient with a severely tortuous right coronary artery (RCA) underwent PCI.
  • Two guidewires were used to straighten the tortuous RCA during the procedure.
  • Immediately after straightening, the patient developed angiographic slow flow, electrocardiographic changes, and anginal pain.

Findings:

  • The patient experienced severe myocardial ischemia.
  • The ischemia was directly attributed to the accordion phenomenon, a consequence of straightening the tortuous RCA.
  • This case highlights a rare but significant complication of PCI in tortuous vessels.

Implications:

  • Awareness of the accordion phenomenon is crucial for interventional cardiologists performing PCI in tortuous coronary arteries.
  • Careful technique and consideration of potential complications are necessary to optimize patient outcomes.
  • Further research may explore preventative strategies or modified approaches for PCI in highly tortuous vessels.

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