Pseudolesion

Overview
A pseudolesion is a stenosis that appears in an artery after the coronary gidewire is placed in the artery.

Risk Factors
Pseudolesions appear in tortuous sections of vessels that have been straightened out by the guidewire. Tortuous right coronary arteries and left internal mammary arteries are at risk for pseudolesion formation.

Differential Diagnosis
A pseudolesion must be distinguished from a dissection or coronary spasm.

Diagnosis
A pseudolesion will usually disappear if the wire is withdrawn to the distal edge of the lesion and the vessel is allowed to assume its normal shape. Sometimes replacement of a stiff wire with a more flexible floppy wire eliminates that pseudolesion. In addition, either a microcatheter or a balloon catheter can be placed distal to the lesion and this will sometimes eliminate the pseudolesion. If the balloon kinks at the site of vessel tortuosity, then it can be hard to reintroduce the wire. A pseudolesion should completely disappear after the wire is withdrawn from the coronary artery.

Treatment
Pseudolesions should not be stented or dilated!

Complications
In some cases pseudolesions may cause hemodynamic compromise and ischemia. Inadvertent stenting of pseudolesions by overzealous interventional cardiologists.