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The accordion phenomenon/Akordiyon fenomeni.

A 60-year-old woman, with a history of arterial hypertension was referred to our clinic for elective percutaneous coronary intervention (PCI) to the distal right coronary artery (RCA) stenosis. Right coronary ostium cannulated with a 6 French JR 4 guiding catheter. Because of the tortuosity of the vessel, a 0.014 inch extra support guidewire (Asahi Intecc Co., Ltd., Aichi, Japan) was cho-sen to improve the accessibility to the target stenosis (Fig. 1A). After crossing stenosis with the guidewire, RCA was straightened and a new dissection-like lesion appeared in the straightened part of RCA (Fig. 1B). We considered dissection and "accordion" phenomenon as main diagnostic possibilities. We also gave intracoronary nitroglycerine to rule out coronary spasm, with no change in the lesion. Because there was no coronary flow impairment, we decided to continue the procedure. A 3.0 X 9 mm Ephesos stent (Nemed Manufacturing Inc., Istanbul, Turkey) was implanted with direct stenting technique to distal RCA stenosis with a good angiographic result, but dissection-like lesion continued to be present. Because of high possibility of "accordion" effect, we withdrew the guidewire and a repeat angiogram revealed that the lesion resolved (Fig. 1C).


This case demonstrates that straightening of a tortuous coronary artery due to a stiff guidewire may result in dissection-like lesions named the "accordion" phenomenon. This phenomenon must be recognized if potentially deleterious and further PCI should be avoided.

Sedat Turkoglu, Timur Timurkaynak

Department of Cardiology, Faculty of Medicine, Gazi University, Ankara, Turkey

Address for Correspondence/Yazisma adresi: Dr. Sedat Turkoglu, Gazi Universitesi Tip Fakultesi, Kardiyoloji Anabilim Dali, 06500, Besevler, Ankara, Turkiye Fax: +90 312 212 90 12 Phone : +90 312 202 56 29 E-mail:
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Title Annotation:E-page Original Images/E-sayfa Orijinal Goruntuler
Author:Turkoglu, Sedat; Timurkaynak, Timur
Publication:The Anatolian Journal of Cardiology (Anadolu Kardiyoloji Dergisi)
Article Type:Brief article
Geographic Code:7TURK
Date:Apr 1, 2008
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