A 75-year old lady with previous stenting of the mid-portion of the right coronary artery (RCA) and left anterior descendens (LAD) had recurrence of typical exertional angina despite optimal medical treatment and was scheduled for coronary angiography. This showed a moderate to severe in-stent restenosis (Fig. 1a, arrow) in a tortuous RCA and a prominent curve between mid-and distal RCA (Fig. 1a, arrowhead). After pre-dilatation and stenting using a drug-eluting stent, the angiogram with angioplasty guidewire in situ showed a good result at the stented section, but a new ‘stenosis’ at the border between mid- and distal RCA (Fig. 1b, arrow). As the curve between mid- and distal RCA had disappeared, we suspected a ‘concertina’-phenomenon which was confirmed upon partial withdrawal of the guide-wire: the curve re-appeared (Fig. 1c, arrowhead) and the ‘stenosis’ disappeared. Final angiogram after complete withdrawal of guidewire (Fig. 1d) revealed a satisfactory end-result.
Fig. 1
a LAO projection showing a moderate to severe in-stent restenosis in the mid-RCA (arrow) and a prominent curve between the mid- and distal RCA. b angiogram with angioplasty guidewire in situ shows a new ‘stenosis’ (arrow) and disappearance of the curve between mid- and distal RCA. c upon partial withdrawal of the guidewire, the curve reappears (arrowhead) and the pseudo-stenosis disappears. d final angiogram showing satisfactory result of stenting (arrow)