A case of an entrapped rotational atherectomy burr

Successful retrieval of an entrapped rotablator burr using 5 Fr guiding catheter

“…Pulling back the stuck burr by a percutaneous snare might be safer and less traumatic than simple manual pull back [2]. In contrast, recrossing another guidewire just beside the entrapped burr and making a crack between the burr and vessel wall by inflating a balloon catheter might be a more promising strategy [3,4]. In this setting, a tapered hard-type guidewire is sometimes necessary to cross burr-stuck lesion, as seen in the present case [4].…”

“…Although burr entrapment is a rare complication of rotational atherectomy, it is extremely difficult to retrieve a fixedly entrapped burr without surgical procedure [1]. In addition, experience in non-surgical removal of stuck burr has been extremely limited [2][3][4]. We describe a successful attempt to retrieve an entrapped rotablator burr using 5 Fr straight guiding catheter.…”

Penetrating might be easier than retrieving

“…Although they could inflate a 1.5 mm balloon with high pressure, they could not retrieve the burr. This scenario is different from the case presented by Grise et al [3], where the mechanism of the burr entrapment was also supposed to be Kokesi phenomenon. What happened in this case?…”

“…The first procedure is an emergency bypass surgery [1]. The second one is to pass the second PCI guidewire and dilate a balloon along the trapped burr [3]. The final one is to cut off the rotablator shaft near the advancer, catch the distal part of the rotablator shaft by the snare advanced along the shaft, and retrieve the trapped burr from the lesion [4].…”

Getting out of jail: Creative solutions in a moment of crisis

“…In-depth knowledge of the equipment we use in the cardiac catheterization laboratory is critical [3]: had the authors not been familiar with the design of the Rotablator catheter, they may not have come up with the idea of removing the drive shaft sheath to allow insertion of a balloon through the guide catheter. Using a second guide catheter [4], or a snare [5], or guide exchange over the Rotablator catheter shaft [6] are alternative, albeit more cumbersome, previously published solutions.…”