Creation of pseudo narrowing during coronary angioplasty

Since the initial description of percutaneous transluminal coronary angioplasty (PTCA) by Gruentzig et al,¹ the application of PTCA has expanded dramatically, exceeding 300,000 cases annually. Along with this growth, patients with increasingly complex coronary arterial anatomy and lesions are being treated. Technologic advances, coupled with operator experience, have reduced acute procedural risk to an acceptable, although not negligible, level.² During the performance of PTCA, the interventional cardiologist must quickly recognize and appropriately manage any complication that arises. In addition, the operator must be able to differentiate true complications from pseudocomplications; that is, the operator must recognize the artifactual nature of an apparent complication that is not necessarily what it appears to be. For instance, Espluges et al³ reported the appearance of persistent staining by contrast material of the arterial wall, suggesting significant dissection during PTCA while using a new monorail balloon catheter. The artifact disappeared with balloon deflation³. We report a patient in whom straightening of a tortuous coronary artery by a PTCA guidewire created the false impression of 2 new narrowings during PTCA.