The limited antegrade subintimal tracking technique to retrieve a trapped rotablator burr: a case report

Abstract

Background Burr entrapment is a rare, but potentially serious complication of rotablation. This report describes the percutaneous options available for Rota burr retrieval. Case summary A 62 year old, caucasian man with stable angina, presented for percutaneous coronary intervention. Attempted rotablation with a 1.75 mm burr resulted in Rota burr entrapment, in the heavily calcified proximal right coronary artery. A chronic total occlusion angioplasty technique (Limited Antegrade Subintimal Tracking) was successfully used to remove the trapped Rota burr, by enabling subintimal dilatation to externally crush plaque and dislodge the burr. The angioplasty procedure was then completed using the wire that had short subintimal passage, before re-entering the true lumen. Discussion The mechanism for Rota burr entrapment in this case, was initiating rotablation on the heavily calcified lesion and not more proximal to allow a pecking motion. The learning points are: (i) to start the rotablator several millimeters proximal to the actual lesion; and (ii) if unable to wire alongside a trapped Rota burr in the true lumen, then subintimal crossing and balloon dilatation in the subintimal space may work to dislodge the burr.