Clinical Images

Concertina Effect

 Rakesh Agarwal, MD, DM and Dhurjati Prasad Sinha, MD, DM

 Rakesh Agarwal, MD, DM and Dhurjati Prasad Sinha, MD, DM

J INVASIVE CARDIOL 2020;32(5):E139.

Key words: angioplasty, percutaneous coronary intervention, pseudolesion


A 40-year-old male was admitted to the cardiology department with inferior-wall myocardial infarction. He was taken to the cardiac catheterization laboratory with an intent for primary percutaneous intervention. During coronary angiography, he was found to have significant stenosis in the mid part of a tortuous right coronary artery (Figure 1A). Percutaneous transluminal coronary angioplasty was decided upon and a Runthrough floppy guidewire (Terumo) was passed. There was immediate appearance of a series of new “pseudolesions” in the right coronary artery (Figure 1B and Video 1). A drug-eluting stent was placed across the lesion with guidance of anatomical landmarks. The pseudolesions persisted after stent placement (Figure 1C). The lesions disappeared with the final check angiography shot after removal of the guidewire (Figure 1D).

Accordion effect or concertina effect — also known as “crumpled coronary” — is an uncommon occurrence during coronary angioplasty. It occurs due to straightening of a tortuous coronary artery along its luminal axis by relatively stiff coronary equipment due to invagination of excess tissue. It usually has no major clinical sequelae and should be differentiated from spasm, dissection, and thrombosis, which require special management. 


From the Institute of Postgraduate Medical Education and Research, Kolkata, India.

Disclosure: The authors have completed and returned the ICMJE Form for Disclosure of Potential Conflicts of Interest. The authors report no conflicts of interest regarding the content herein. 

The authors report that patient consent was provided for publication of the images used herein.

Manuscript accepted August 28, 2019.

Address for correspondence: Rakesh Agarwal, MBBS, MD, CCEBDM, PGPC, DM (Cardiology), Senior Resident, Cardiology, IPGME&R and SSKM Hospital, Kolkata 243, G.T. Road(N), Laxmi Niketan, Flat-2E, Liluah, Howrah-711204 India. Email: dr.agarwal.rakesh@hotmail.com

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