Stuck rotablator: the nightmare of rotational atherectomy

Sulimov, Dmitriy S.; Abdel‐Wahab, Mohamed; Töelg, Ralph; Kassner, Guido; Geist, Volker; Richardt, Gert

doi:10.4244/eijv9i2a41

Cited by 59 publications

(31 citation statements)

References 18 publications

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“…The perforation rate after OA use is in the low end of the previously reported range, and the final ORBIT II perforation rate is within the range. Despite these successes, other reports suggest that distal embolisation of atherectomy fragments may result in slow-flow or no-reflow, which can result in serious complications such as adverse ischaemic and clinical events including, but not limited to, microvascular spasm, MI, and no-reflow phenomenon [16,17]. RA has been proven to be superior to other atherectomy devices with respect to plaque modification.…”

Section: Discussionmentioning

confidence: 98%

Long-term effects of rotational atherectomy in patients with heavy calcified coronary artery lesions: a single-centre experience

Bartuś¹,

Januszek

Legutko³

et al. 2017

Kardiol Pol

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A b s t r a c tBackground: Rotational atherectomy (RA) plays a significant role in contemporary percutaneous coronary interventions (PCI), especially in the era of population aging and expansion of PCI indications. Aim:The aim of the current study was to evaluate the rate of periprocedural complications, the long-term effectiveness of RA, and potential factors influencing the incidence of major adverse cardiac events (MACE) and major cardiac as well as cerebrovascular events (MACCE) after RA. Methods:The study included 60 consecutive patients who underwent effective RA between January 2002 and May 2016. Patients were followed-up for 2,616 days for MACE and MACCE. Results:The mean age of the enrolled patients was 72.1 years, and 78.3% were males. The mean follow-up period lasted 835.3 ± 611.8 days. Periprocedural complications occurred in 12 (20.0%) patients. In the follow-up of up to 2,616 days, 64% of patients were free of MACCE and 68% were free of MACE. Univariate Cox analysis revealed that MACCE occurred more often in patients from the high-risk group based on the EuroSCORE II and those with longer lengths of the implanted stent(s) after the RA procedure. In multivariate Cox regression analysis, both high-risk category and mean stent(s) length were identified as independent predictors of MACCE. EuroSCORE II was confirmed to be the only independent predictor of MACE after RA. Conclusions:Rotational atherectomy is a safe and sufficient technique for the endovascular treatment of heavily calcified coronary artery lesions. Individuals at a higher risk as assessed by the EuroSCORE II before RA and those with longer stent(s) implanted after RA are predisposed to MACCE in the follow-up.

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Section: Discussionmentioning

confidence: 98%

Long-term effects of rotational atherectomy in patients with heavy calcified coronary artery lesions: a single-centre experience

Bartuś¹,

Januszek

Legutko³

et al. 2017

Kardiol Pol

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“…RA with subsequent bare metal stent (BMS) or drug‐eluting stent (DES) implantation improves the clinical outcomes of patients with calcified coronary artery disease (CAD) 1, 2, 3, 4, 5, 6, 7, 8 and procedure‐related major adverse cardiac events (MACE) along with mid‐ to long‐term mortality have all been at acceptable levels. Nonetheless, RA is still a technically demanding method requiring scrupulous execution, which may explain why it is seldom used in everyday interventional practice 9, 10, 11. Present‐day RA is, in our view, thus preserved for diffuse, highly calcified, severely fibrotic lesions: stenoses that seem or prove refractory to balloon manipulation efforts.…”

Section: Introductionmentioning

confidence: 99%

Clinical predictors of mortality following rotational atherectomy and stent implantation in high‐risk patients: A single center experience

Édes

Ruzsa

Szabó

et al. 2015

Cathet Cardio Intervent

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ObjectivesOur aim was to assess the procedural success and determine the clinical predictors of postprocedure mortality, following rotational atherectomy (RA) and stenting in high‐risk patients.BackgroundRA is mainly used to facilitate stenting in complex lesions. Outcomes involving RA and stenting have been investigated, yet high‐risk patients have not been adequately described.MethodsData of 218 consecutive patients who underwent RA were evaluated in a prospective register. Primary endpoints were the angiographic success and long‐term mortality. Secondary endpoints were procedural success, consumption of the angioplasty equipment, and periprocedural major adverse cardiac events. The impact of the relevant angiographic and clinical characteristics on long‐term mortality was analyzed using uni‐ and multivariate Cox regression analysis.ResultsMean age of the patients was 70 ± 8.2 years, diabetes was present in 44%, and chronic renal failure in 29%. Prior myocardial infarction and three‐vessel disease amounted to 42.2% and 32.6%, respectively. Altogether, 52.8% of patients underwent RA after a failed, non‐RA intervention attempt, and 30.7% of cases presented as acute coronary syndromes. Angiographic success was 100%, and all patients received stents after RA. Periprocedural major adverse cardiac events occurred in five (2.3%) patients. Postprocedural death was investigated, with a mean follow‐up of 36 months. Mortality amounted to 37.2%. Multivariate analysis revealed that left ventricular ejection fraction < 50%, glomerular filtration rate < 60 ml/min, cardiogenic shock, and diabetes were the only independent mortality predictors.ConclusionsWe have found that RA and stenting is feasible and viable in an elderly high‐risk population, with exceptional procedural success and acceptable long‐term results. © 2015 Wiley Periodicals, Inc.

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“…An entrapped rotablator burr is a rare but severe complication of RA, which can cause severe ischemia with ST elevation, requiring immediate reperfusion . Some case reports of useful bailout procedures and an algorithm for the management of an entrapped burr have been published; however, catheter‐based bailout remains technically challenging, and in the worst scenario, this critical condition can necessitate emergency cardiac surgery .…”

Section: Introductionmentioning

confidence: 99%

Successful retrieval of a firmly stuck rotablator burr by using a modified STAR technique

Tanaka

Saïto

2015

Cathet Cardio Intervent

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Rotablator burr entrapment occurring during rotational atherectomy is a rare but serious complication that can lead to coronary occlusion and require emergency cardiac surgery. Although several bailout techniques for stuck burrs have been proposed, no definitive methods for removal have been established. We report here a difficult case of a stuck rotablator burr, in which various techniques failed to retrieve the burr. It was ultimately removed using the subintimal tracking and reentry (STAR) technique with a 3-g tapered tip hydrophilic wire. This modified STAR technique, which was originally developed for percutaneous coronary intervention for chronic total occlusion, may be useful as a bailout technique in patients with a firmly stuck rotablator burr that cannot be removed by using standard procedures.

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Stuck rotablator: the nightmare of rotational atherectomy

Abstract: Entrapment of a rotablation burr is a rare but very serious complication of RA. Operators performing RA should be aware of this risk and be prepared to manage it adequately. In our experience, the risk seems to be higher when rotablating freshly implanted underexpanded stents.

Cited by 59 publications

References 18 publications

Long-term effects of rotational atherectomy in patients with heavy calcified coronary artery lesions: a single-centre experience

Long-term effects of rotational atherectomy in patients with heavy calcified coronary artery lesions: a single-centre experience

Clinical predictors of mortality following rotational atherectomy and stent implantation in high‐risk patients: A single center experience

Successful retrieval of a firmly stuck rotablator burr by using a modified STAR technique

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