Surgical removal of rotational atherectomy device

Abstract

Video clip is available online.Rotational atherectomy emerged in the 1990s and is used in percutaneous coronary intervention to manage calcified lesions. Rotational atherectomy uses a diamond-tipped burr that rotates and ablates plaque as it advances over a guidewire that is placed across a lesion. Burr entrapment is a known complication because if the burr passes beyond an incompletely destroyed plaque, it can be impossible to remove because the back of the burr cannot ablate in a retrograde fashion. Pulling vigorously on the device from outside the body can cause coronary artery dissection and rupture. There are catheter-based techniques for removal, 1 including passing a second guidewire for angioplasty of the stuck segment, and use of snares. 2 However, although there are many reports of catheter-based removal, there are few reports of surgical removal that include technical detail. 3,4 Our goal is to review the technical details of a single case, and provide some underlying principles.

Commentary: Cath lab 911

“…In this issue of JTCVS Techniques , Waterford and colleagues 5 present a case that brings to light the specific complication of burr entrapment that cardiac surgeons may face during their career. Atherectomy is associated with greater coronary artery perforation rates of 1.0% to 2.0%, 6 , 7 , 8 often attributed to oversizing and forceful advancement of the burr.…”

Commentary: When the going gets… stuck

“…Waterford and colleagues 7 report the case of a patient with a history of coronary artery bypass grafting who underwent coronary catheterization 8 years afterward for recurrence of symptoms. The patient was offered RA for treating a calcified lesion in the mid segment of the left anterior descending artery, distal to the anastomotic site of the failed graft.…”

“…Waterford and colleagues 7 must be congratulated for enriching the existing literature on this topic with an additional case report, and for simultaneously summarizing technical pearls for the surgical management of this rare, yet potentially severe, complication.…”