"Concertina" effect during angioplasty of tortuous right and left coronary arteries and importance of using over-the-wire system: a case report.

“Concertina” or “accordion” effect is the appearance of artefactual or pseudolesions during the course of percutaneous transluminal coronary angioplasty (PTCA) in tortuous vessels. The mechanism generally suggested is the partial straightening of a tortuous coronary artery by the coronary guidewire that causes mechanical invagination of the coronary arterial wall at various sites. Those performing angioplasties must be familiar with the appearance and mechanisms thereof, as failure to do so may lead to inappropriate intervention with its attendant risks. We describe a case in which the “concertina” effect appeared during the course of balloon angioplasty of both the right and left coronary arteries (RCA and LCA). The advantages of using an over-the-wire (OTW) system in arriving at a correct diagnosis and its successful management are also highlighted.