Coronary accordion effect mimicking coronary dissection in a 41-year-old male during angiography procedure an interesting case report

Abstract

The accordion phenomenon is a rare pseudo-complication observed during percutaneous coronary intervention (PCI), which can mimic coronary dissection, spasm, or thrombus formation. Here we present a patient with inferior ST-segment elevation myocardial infarction (STEMI), who developed multiple pseudo lesions in the tortuous right coronary artery (RCA) during PCI. An emergency coronary angiography was performed, but unfortunately, the lesion developed into an accordion-like shape in the middle segment of the right coronary artery (RCA), which looked like a coronary dissection. Despite attempts to resolve the abnormality with intracoronary nitrates, the accordion effect persisted, leading to a drop in blood pressure. Subsequent administration of isotonic solution and additional intracoronary nitrates eventually alleviated the dissection pattern. Due to the small diameter of the posterior descending artery, balloon angioplasty was performed to complete the procedure successfully. The patient was discharged 2 days later with a prescribed regimen of aspirin, prasugrel, atorvastatin, and carvedilol. Follow-up after 1 week indicated the patient's well-being, with no reported complaints.

Keywords

• Coronary angiography
• Coronary artery disease
• Electrocardiography
• Coronary vessels