Successful retrieval of a firmly stuck rotablator burr by using a modified <scp>STAR</scp> technique

Tanaka, Yutaka; Saïto, Shigeru

doi:10.1002/ccd.26342

Cited by 23 publications

(12 citation statements)

References 11 publications

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“…Percutaneous salvage options include: pulling the RA wire using its 0.014 inch spring tip combined with push and pull on the drive shaft; balloon dilation proximal to the entrapped burr via same or different guide catheter from a different access site; deep intubation of guiding catheter or cutting the burr drive shaft with insertion of a mother-in-child catheter; and subintimal tracking and re-entry with balloon dilatation adjacent to the trapped burr. [14,79–81] If retrieval is unsuccessful with the above catheter-based techniques, a cardiac surgery consultation will be necessary.…”

Section: Complications Of Rotational Atherectomymentioning

confidence: 99%

Rotational Atherectomy: A Contemporary Appraisal

et al. 2019

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Rotational atherectomy (RA) is an atheroablative technology that enables percutaneous coronary intervention for complex, calcified coronary lesions. RA works on the principle of ‘differential cutting’ and preferentially ablates hard, inelastic, calcified plaque. The objective of RA use has evolved from plaque debulking to plaque modification to enable balloon angioplasty and optimal stent expansion. The clinical experience over the past 30 years has informed the current best practices for RA with use of smaller burr sizes, short ablation runs a ‘pecking’ motion, and avoidance of sudden decelerations. This has led to significant improvements in procedural safety and a reduced rate of associated complications. This article reviews the principles, clinical indications, contemporary evidence, technical considerations and complications associated with the use of RA.

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Section: Complications Of Rotational Atherectomymentioning

confidence: 99%

Rotational Atherectomy: A Contemporary Appraisal

et al. 2019

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“…The mechanism of orbital atherectomy crown entrapment/strain in this case is different from that of rotational atherectomy. Device entrapment in rotational atherectomy has previously been reported in the literature . The mechanism of entrapment of rotational atherectomy burrs has been described using the analogy of the Kokeshi dolls originating in northeastern Japan.…”

Section: Discussionmentioning

confidence: 99%

“…Previously proposed approaches for entrapped rotational atherectomy burrs include recrossing and balloon inflation over a second wire , removal with a snare , removal with mother‐and‐child catheters , use of the subintimal space to dislodge the burr , and surgical removal . In our case, we modified the first approach by first protecting the vessel with a second wire, and then gently removing the device using a tapered tip microcatheter to both stabilize the dislodged tip and to facilitate removal.…”

Section: Discussionmentioning

confidence: 99%

Broken arrow: Successful retrieval of a dislodged coronary orbital atherectomy microtip

Hirai

Rosenberg

Nathan

et al. 2018

Cathet Cardio Intervent

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A 68-year-old female with a history of coronary artery disease and prior bypass surgery presented for staged percutaneous coronary intervention (PCI) to a calcified and angulated ostial left circumflex (LCX) artery lesion after PCI of the anastomosis of the left internal mammary artery - to left anterior descending artery. Orbital atherectomy of the LCX was performed at a speed of 80,000 RPM with multiple passes, and was complicated by device microtip dislodgement and entrapment within the vessel. After advancing a "buddy" wire beyond the microtip, a tapered microcatheter was advanced over the ViperWire and into the edge of the broken microtip and torqued into the microtip with forward pressure using the 0.014 in ViperWire tip as a "backstop." The guidewire, microcatheter, and microtip were then successfully removed as a unit and the intervention with stent placement was completed over the "buddy" wire. Scanning electron microscopy of the shaft revealed evidence of cyclic fatigue, indicating that the fracture occurred while spinning. The fracture when performing atherectomy in a model coronary artery with a radius of approximately 6 mm. This represents a first case of microtip dislodgement and entrapment during the use of a coronary orbital atherctomy device.short.

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“…In extreme cases, surgical removal might be indicated. An extensive dissertation on how to deal with an entrapped burr can be found elsewhere .…”

Section: Discussionmentioning

confidence: 99%

Rotational atherectomy in the subadventitial space to allow safe and successful chronic total occlusion recanalization: Pushing the limit further

Capretti

Carlino

Colombo

et al. 2017

Cathet Cardio Intervent

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Dissection and re-entry (DR) techniques have played a key role in the increase of success rates of chronic total occlusion (CTO) recanalization. DR usually allows wiring complex occlusions, even in case of important calcification. In extreme cases, such as in balloon failure-to-cross, rotational atherectomy (RA) might be decisive. However, according to experts' recommendations, RA should not be performed in dissection planes because of the high risk of perforation and further extending the dissection, so that its use after DR might be limited. Here, we describe a case of successful right coronary artery CTO recanalization in which, after failure of several antegrade and retrograde techniques, RA was safely performed antegradely in the subadventitial space, thus eventually enabling reverse controlled antegrade and retrograde subintimal tracking (CART). Although the feasibility of RA in CTO percutaneous coronary intervention had already been suggested, this case reports on the novel use of RA to allow further manipulation of the subadventitial space (reverse CART) prior to successful recanalization. V C 2017 Wiley Periodicals, Inc.

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

Cited by 23 publications

References 11 publications

Rotational Atherectomy: A Contemporary Appraisal

Rotational Atherectomy: A Contemporary Appraisal

Broken arrow: Successful retrieval of a dislodged coronary orbital atherectomy microtip

Rotational atherectomy in the subadventitial space to allow safe and successful chronic total occlusion recanalization: Pushing the limit further

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