How should I treat an entrapped rotational atherectomy burr?

Vroey, Frederic De; Velavan, Periaswamy; Jack, Seif El; Webster, Mark

doi:10.4244/eijv7i10a197

“…Several techniques have been suggested to overcome this complication. 44,45 One option is to pull firmly and continuously on the burr, being careful of the protrusion of the guide catheter into the artery, which can also cause proximal dissection. Another option is to use a second wire and attempt to inflate a very small balloon, at low pressure, at the site where the burr is stuck.…”

Section: Complicationsmentioning

confidence: 99%

Rotational atherectomy: Technical update

Mota

¹

,

Belder²,

Leitão‐Marques

³

2015

Revista Portuguesa de Cardiologia

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Percutaneous coronary intervention is currently the most common form of revascularization for symptomatic coronary artery disease. In elderly, diabetic and renal patients, there is an increased prevalence of calcified coronary disease. Rotational atherectomy (RA) can be useful in the treatment of these lesions. Plaque removal was initially proposed as an alternative to balloon angioplasty, hence RA required high-velocity protocols with large-sized burrs (over 2.0 mm). With a high incidence of acute complications and disappointing restenosis rates, the use of RA dwindled. However, the advent of drug-eluting stents, which significantly decreased the rate of restenosis, led to the repositioning of RA as an adjunctive technique in the preparation of densely calcified lesions, improving stent delivery and expansion. In recent years, a better understanding of the mechanism of action of RA has changed it from a plaque debulking to a compliance modifying technique. As a result, RA has become less aggressive, using smaller size burrs and lower rotational speeds. This conservative approach has improved immediate results, with increased safety and better long-term outcomes. In this review paper, the technique of RA is explained in the light of current knowledge.

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“…Deep intubation with guiding catheters with subsequent pullback can be useful to focus the force on the burr and to protect the rest of the coronary artery. 11,12 Relieves spasm Effective if rotaglide®/vasodilator solution is not used due to specific contraindication, additive to other mechanisms, not possible in a hemodynamically unstable patient. 2…”

Section: Management Of Stuck Rotablator Burrmentioning

confidence: 99%

Percutaneous management of Stuck Rotational Atherectomy Burr: Experience at a tertiary care centre

Raj

¹

,

Nath

²

,

Thakur

³

et al. 2021

Asian J Med Sci

0

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Background: The incidence of stuck rotational atherectomy (RA) burr is extremely low, and its description has been sporadic in the literature about the systemic management of this complication. Aims and Objective: The current study was designed to present the experience of our center and propose an algorithm for the retrieval of stuck RA burr. Materials and Methods: We retrospectively evaluated cases of RA between August 2018 to August 2020 at our center. An entrapped RA burr was defined as an inability to move the burr backward without any additional maneuvers during or after the rotablation of a coronary lesion. Angiographic and procedural details were reviewed in the identified cases of entrapped rotablator burr, details of maneuvers used to retract the burr was documented. We further analyzed the literature using PubMed search using the keywords “entrapment of rotablator burr”, “stuck rotablator” and “rotablation complications”. All the articles with entrapped rotablation burr were identified and scrutinized for the techniques used for percutaneous retrieval. Results: Out of the total 5780 Percutaneous coronary intervention (PCI) procedures, RA was performed in 75 patients and RA burr entrapment was confirmed in two cases. Both the cases were seen in patients with angulated and heavily calcified lesions. The cases were managed percutaneously by endovascular maneuvers. A total of 8 techniques were identified by analysis of available literature for burr retrieval with surgery being the favored one. Using the experience of our center and available literature we propose a simplified working algorithm towards systematic management of this complication. Conclusion: RA burr entrapment is rare, but a life-threatening complication, and the operator should be prepared with strategies for successful retrieval of stuck burr. Percutaneous retraction maneuvers should be used as the first-line management for retrieval of stuck burr followed by surgical referral. Using the proposed algorithm this rare complication can be managed systematically and effectively.

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“…44,45 One option is to pull firmly and continuously on the burr, being careful of the protrusion of the guide catheter into the artery, which can also cause proximal dissection. This can be due to an oversized burr, lengthy burr displacements, excessively forceful strokes rather than pecking movements, or interruption of ablation with the burr distal to the lesion.…”

Section: Complicationsmentioning

confidence: 99%

Rotational atherectomy: Technical update

Mota

¹

,

Belder²,

Leitão‐Marques

³

2015

Revista Portuguesa de Cardiologia (English Edition)

View full text Add to dashboard Cite

Percutaneous coronary intervention is currently the most common form of revascularization for symptomatic coronary artery disease. In elderly, diabetic and renal patients, there is an increased prevalence of calcified coronary disease. Rotational atherectomy (RA) can be useful in the treatment of these lesions.Plaque removal was initially proposed as an alternative to balloon angioplasty, hence RA required high-velocity protocols with large-sized burrs (over 2.0 mm). With a high incidence of acute complications and disappointing restenosis rates, the use of RA dwindled. However, the advent of drug-eluting stents, which significantly decreased the rate of restenosis, led to the repositioning of RA as an adjunctive technique in the preparation of densely calcified lesions, improving stent delivery and expansion.In recent years, a better understanding of the mechanism of action of RA has changed it from a plaque debulking to a compliance modifying technique. As a result, RA has become less aggressive, using smaller size burrs and lower rotational speeds. This conservative approach has improved immediate results, with increased safety and better long-term outcomes.In this review paper, the technique of RA is explained in the light of current knowledge.Aterectomia rotacional; Técnica de aterectomia rotacional; Aterectomia rotacional ---aspetos atuais da técnicaResumo A angioplastia coronária tornou-se a forma mais habitual de revascularização miocárdica na doença coronária sintomática. Na população mais idosa, nos diabéticos e nos doentes com insuficiência renal crónica, a prevalência de lesões calcificadas tende a aumentar. A aterectomia rotacional (AR) é uma técnica de grande utilidade no tratamento destas situações. 272P. Mota et al. Intervenção coronária percutânea; Calcificação coronáriaTendo-se considerado inicialmente que a erosão da placa podia constituir uma alternativa à angioplastia de balão, a técnica de aterectomia rotacional utilizava protocolos de alta velocidade com olivas que ultrapassavam os 2,0 mm de diâmetro. A ocorrência de complicações agudas e resultados insuficientes a longo prazo limitaram a sua difusão. O aparecimento dos stents com fármaco com redução significativa das taxas de reestenose, levou ao reposicionamento da aterectomia rotacional como técnica adjuvante na preparação das lesões permitindo uma melhor entrega e expansão dos stents, no contexto de doença aterosclerótica calcificada.Nos últimos anos, tem-se assistido a uma melhor compreensão do mecanismo de acção da aterectomia rotacional que passou de debulking para modificação de compliance da placa. Consequentemente, a técnica tem-se tornado menos agressiva: utilizam-se olivas de menor calibre, com menor velocidade de rotação, alcançando-se elevadas taxas de sucesso e de segurança no procedimento.Neste artigo procuramos reunir o conhecimento atual sobre como executar a técnica de aterectomia rotacional.

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How should I treat an entrapped rotational atherectomy burr?

Cited by 14 publications

References 13 publications

Rotational atherectomy: Technical update

Rotational atherectomy: Technical update

Percutaneous management of Stuck Rotational Atherectomy Burr: Experience at a tertiary care centre

Rotational atherectomy: Technical update

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