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A 75 year old woman with symptomatic hypertrophic cardiomyopathy and a left ventricular outflow tract gradient under stress exceeding 100 mm Hg was admitted for alcohol septal ablation. Panel A shows an apparent stenosis in the proximal right coronary artery identified at coronary angiography (left anterior oblique (LAO) 20°, cranial 20°) immediately pre-procedure. After the ablation procedure, it was elected to perform percutaneous coronary intervention on this lesion. On passage of a Balance middleweight wire to the distal vessel, however, the “stenosis” resolved (panel B). The lesion reappeared when the wire was withdrawn and resolved again when the wire was passed back down the vessel. It was concluded that this apparent lesion represented a kink in the vessel and no intervention was performed.
It is well recognised that conformational change of a vessel wall by an angioplasty wire can cause appearances suggestive of coronary stenosis or dissection. Such a “wire artefact” occurs most commonly when the wire results in straightening of a tortuous vessel causing rucking of the vessel wall. These images demonstrate quite the reverse—an apparent stenosis that is abolished, rather than caused, by passage of an angioplasty wire.