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Maznyczka A, Mozid A. The limited antegrade subintimal tracking technique to retrieve a trapped rotablator burr: a case report. Eur Heart J Case Rep 2024; 8:ytae044. [PMID: 38328602 PMCID: PMC10849080 DOI: 10.1093/ehjcr/ytae044] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2023] [Revised: 01/06/2024] [Accepted: 01/23/2024] [Indexed: 02/09/2024]
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 a 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 millimetres 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.
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Affiliation(s)
- Annette Maznyczka
- Swiss Cardiovascular Center, Bern University Hospital, Freiburgstrasse 18, Bern CH-3010, Switzerland
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2
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Tehrani DM, Seto AH. Management of Coronary Complications. Interv Cardiol Clin 2022; 11:445-453. [PMID: 36243489 DOI: 10.1016/j.iccl.2022.06.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/16/2023]
Abstract
Coronary complications are increasingly rare but remain fatal if not managed promptly and effectively. We review the incidence, management, and prevention of the most serious coronary complications including acute vessel closure from dissection, no-reflow, thrombosis, and air embolism as well as mechanical complications including perforation, stent dislodgment, and atherectomy burr entrapment.
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Affiliation(s)
- David M Tehrani
- University of California Los Angeles, 650 Charles East Young Drive South, A20237 CHS, Los Angeles, CA 90095, USA.
| | - Arnold H Seto
- Long Beach Veterans Administration Medical Center, 5901 East 7th Street 111C, Long Beach, CA 90822, USA
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Sanz‐Sánchez J, Mashayekhi K, Agostoni P, Egred M, Avran A, Kalyanasundaram A, Garbo R, Colombo A, Regazzoli D, Reimers B, Brilakis ES, Gasparini GL. Device entrapment during percutaneous coronary intervention. Catheter Cardiovasc Interv 2022; 99:1766-1777. [PMID: 35312151 PMCID: PMC9544850 DOI: 10.1002/ccd.30160] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/08/2021] [Revised: 01/20/2022] [Accepted: 03/05/2022] [Indexed: 12/11/2022]
Abstract
INTRODUCTION Device entrapment is a life-threatening complication during percutaneous coronary intervention (PCI). However, the success for its management is predominantly based on operator experience with limited available guidance in the published literature. METHODS A systematic review was performed on December 2021; we searched PubMed for articles on device entrapment during PCI. In addition, backward snowballing (i.e., review of references from identified articles and pertinent reviews) was employed. RESULTS A total of 4209 articles were retrieved, of which 150 studies were included in the synthesis of the data. A methodical algorithmic approach to prevention and management of device entrapment can help to optimize outcomes. The recommended sequence of steps are as follows: (a) pulling, (b) trapping, (c) snaring, (d) plaque modification, (e) telescoping, and (f) surgery. CONCLUSIONS In-depth knowledge of the techniques and necessary tools can help optimize the likelihood of successful equipment retrieval and minimization of complications.
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Affiliation(s)
- Jorge Sanz‐Sánchez
- Interventional cardiology UnitHospital Universitari i Politecnic La FeValenciaSpain
- Centro de Investigación Biomedica en Red (CIBERCV)–MadridMadridSpain
| | - Kambis Mashayekhi
- Division of CardiologyUniversity Heart Center Freiburg‐Bad KrozingenBad KrozingenGermany
| | | | - Mohaned Egred
- Department of CardiologyFreeman HospitalNewcastle upon TyneUK
- Division of Cardiology, School of MedicineUniversity of SunderlandSunderlandUK
- Division of Cardiology, Translational and Clinical Research InstituteNewcastle UniversityNewcastle upon TyneUK
| | - Alexandre Avran
- Department of Interventional CardiologyClinique PasteurEssey‐lès‐NancyFrance
| | - Arun Kalyanasundaram
- Interventional Cardiology Unit, Division of CardiologyPromed HospitalChennaiIndia
| | - Roberto Garbo
- Department of Interventional CardiologyMaria Pia HospitalTorinoItaly
| | - Antonio Colombo
- Interventional Cardiology UnitIRCCS Humanitas Clinical and Research CenterMilanItaly
| | - Damiano Regazzoli
- Interventional Cardiology UnitIRCCS Humanitas Clinical and Research CenterMilanItaly
| | - Bernhard Reimers
- Interventional Cardiology UnitIRCCS Humanitas Clinical and Research CenterMilanItaly
| | | | - Gabriele L. Gasparini
- Interventional Cardiology UnitIRCCS Humanitas Clinical and Research CenterMilanItaly
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[Focus on high speed rotational atherectomy by Rotablator in 2021 and datas from France PCI registry]. Ann Cardiol Angeiol (Paris) 2021; 70:435-445. [PMID: 34753597 DOI: 10.1016/j.ancard.2021.10.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2021] [Accepted: 10/02/2021] [Indexed: 11/24/2022]
Abstract
Developed in the late 1980s, rotational atherectomy has raised a lot of hope for its innovative principle of selective ablation, allowing volume reduction (instead of redistribution) of atherosclerotic plaque, while sparing healthy tissue. Long shunned for its disappointing results on restenosis, the Rotablator finally reasserted itself in the 2000s; era of drug eluting stents and coronary angioplasty boom, thus generating emergence of complex lesions. Indeed, the Rotablator has demonstrated an undeniable benefit in complex (type C) and calcified lesions preparation (before stenting), with a procedural success rate of 95%. Although these lesions only represent a small amount (2-3%) of percutaneous coronary interventions (PCI), they remain a technical impasse for plain-old balloon angioplasty strategy, making the Rotablator more suitable for these resistant lesions' treatment. Registry data attest the safety of this therapy, with a rate of peri-procedural complications and in-hospital mortality comparable to conventional angioplasty (France PCI register). However, certain specific, rare but serious complications (burr entrapment, broken Rotawire, coronary perforation) justify trained teams, perfect knowledge of the equipment, and strict compliance with good practice guidelines. In 2018, the rise of a new method of atherectomy by intra-vascular lithotripsy (Shockwave) has coincided with Rotablator decreasing activity (this finding being biased by a general decrease in PCI activity due to Covid pandemic). This therapeutic range's enhancement revolutionizes calcified lesions treatment, tending towards precise targeting of each indication, depending in particular on calcium distribution's anatomy in the plaque.
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Kassimis G, Ziakas A, Didagelos M, Theodoropoulos KC, Hadjimiltiades S. How Should I Get Prepared for and Treat Rota Burr Entrapment in a Focally Underexpanded and Restenosed Stent: A Case Report. CARDIOVASCULAR REVASCULARIZATION MEDICINE 2021; 28S:197-200. [PMID: 34031007 DOI: 10.1016/j.carrev.2021.05.007] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2021] [Revised: 05/07/2021] [Accepted: 05/11/2021] [Indexed: 10/21/2022]
Abstract
Although high-speed rotational atherectomy has been successfully used in selected cases of stent underexpansion secondary to heavy peri-stent calcification, a higher risk of burr entrapment demands extreme caution and surgical back-up on site. The main cause of this complication is the lack of diamond dust on the back end of the burr, which prevents backward ablation of tissues when retracted. To date, only few reports of successful burr retrieval using percutaneous bailout techniques have been published. We report a case of burr entrapment within a previously implanted left circumflex artery stent which was successfully recaptured using the dual catheter technique; following the retrieval the patient underwent routine percutaneous coronary intervention.
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Affiliation(s)
- George Kassimis
- First Cardiology Department, University General Hospital AHEPA, Aristotle University of Thessaloniki, Thessaloniki, Greece; Second Cardiology Department, Hippokration Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece.
| | - Antonios Ziakas
- First Cardiology Department, University General Hospital AHEPA, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Matthaios Didagelos
- First Cardiology Department, University General Hospital AHEPA, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Konstantinos C Theodoropoulos
- First Cardiology Department, University General Hospital AHEPA, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Stavros Hadjimiltiades
- First Cardiology Department, University General Hospital AHEPA, Aristotle University of Thessaloniki, Thessaloniki, Greece
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Benton S, Nicholson WJ. When Things Get Stuck: Gear Entrapment and Other Complications of Chronic Total Occlusion Percutaneous Coronary Intervention. Interv Cardiol Clin 2020; 10:131-145. [PMID: 33223102 DOI: 10.1016/j.iccl.2020.09.007] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Complex coronary artery intervention stresses the limits of both the operator's skills as well as the equipment being used for the procedure. This article is focused on avoiding, recognizing and dealing with device failure and gear entrapment during complex coronary intervention. The operator must understand how to avoid these complications by understanding the limits of devices and the need for adequate vessel preparation. This article focuses on giving the reader an algorithmic approach to recognizing when device failure/entrapment occurs and what specific maneuvers can be done to retrieve different devices and equipment safely.
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Affiliation(s)
- Stewart Benton
- Interventional Cardiology, Wellspan York Hospital, 25 Monument Road, Suite 200, York, PA 17403, USA
| | - William J Nicholson
- Interventional Cardiology, Complex Coronary and Cardiac Intervention, Emory University, Suite F606, 1364 Clifton Road, Atlanta, GA 30322, USA.
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Tehrani S, Achan V, Rathore S. Percutaneous Retrieval of an Entrapped Rotational Atherectomy Burr Using Novel Technique of Controlled Traction and Counter Traction. CARDIOVASCULAR REVASCULARIZATION MEDICINE 2020; 28S:132-135. [PMID: 33191146 DOI: 10.1016/j.carrev.2020.11.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2020] [Revised: 10/31/2020] [Accepted: 11/02/2020] [Indexed: 10/23/2022]
Abstract
Burr entrapment is a rare but serious complication during rotational atherectomy (RA). The Japanese have termed this the Kokeshi phenomenon named after a wooden doll found in northern Japan consisted of a simple trunk but a large head akin to the Rotablator (Mechery et al., 2016; Kaneda et al., 2000). The reason underlying this complication is the lack of diamond dust on the back end of the burr (Lin et al., 2013). The burr is olive-shaped and has diamond coating at its distal surface for antegrade ablation. The proximal part is smooth without diamonds, which prevents backward ablation of tissues when retracted (Lin et al., 2013; Dahdouh et al., 2013). Rota entrapment usually needs surgical management with coronary artery bypass grafting (CABG) surgery. To date, only few cases of successful non-traumatic retrieval using nonsurgical bailout techniques have been published (Grise et al., 2002). We report a case of burr entrapment within the left anterior descending (LAD) artery which was successfully retrieved by combination of multiple maneuvers and the patient underwent routine PCI following the retrieval.
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Affiliation(s)
- Shana Tehrani
- Frimley Health NHS Foundation Trust, Camberley, Surrey GU16 7UJ, United Kingdom.
| | - Vinod Achan
- Frimley Health NHS Foundation Trust, Camberley, Surrey GU16 7UJ, United Kingdom
| | - Sudhir Rathore
- Frimley Health NHS Foundation Trust, Camberley, Surrey GU16 7UJ, United Kingdom
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Giannini F, Candilio L, Mitomo S, Ruparelia N, Chieffo A, Baldetti L, Ponticelli F, Latib A, Colombo A. A Practical Approach to the Management of Complications During Percutaneous Coronary Intervention. JACC Cardiovasc Interv 2019; 11:1797-1810. [PMID: 30236352 DOI: 10.1016/j.jcin.2018.05.052] [Citation(s) in RCA: 47] [Impact Index Per Article: 9.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/07/2018] [Revised: 05/07/2018] [Accepted: 05/29/2018] [Indexed: 12/13/2022]
Abstract
Percutaneous coronary intervention relieves symptoms in patients with chronic ischemic heart disease resistant to optimal medical therapy and alters the natural history of acute coronary syndromes. However, adverse procedural outcomes may occur during the intervention. Knowledge of possible complications and their timely management are essential for the practicing cardiologist and can be life-saving for the patient. In this review, the authors summarize potential complications of percutaneous coronary intervention focusing on their practical management.
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Affiliation(s)
- Francesco Giannini
- Unit of Cardiovascular Interventions, IRCCS San Raffaele Scientific Institute, Milan, Italy.
| | - Luciano Candilio
- Unit of Cardiovascular Interventions, IRCCS San Raffaele Scientific Institute, Milan, Italy; Cardiovascular Department, Hammersmith Hospital, Imperial College, London, United Kingdom
| | - Satoru Mitomo
- Unit of Cardiovascular Interventions, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Neil Ruparelia
- Unit of Cardiovascular Interventions, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Alaide Chieffo
- Unit of Cardiovascular Interventions, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Luca Baldetti
- Unit of Cardiovascular Interventions, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Francesco Ponticelli
- Unit of Cardiovascular Interventions, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Azeem Latib
- Unit of Cardiovascular Interventions, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Antonio Colombo
- Unit of Cardiovascular Interventions, IRCCS San Raffaele Scientific Institute, Milan, Italy
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Hirai T, Rosenberg J, Nathan S, Blair JEA. Broken arrow: Successful retrieval of a dislodged coronary orbital atherectomy microtip. Catheter Cardiovasc Interv 2018; 92:511-514. [DOI: 10.1002/ccd.27674] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/17/2017] [Revised: 04/19/2018] [Accepted: 05/09/2018] [Indexed: 11/06/2022]
Affiliation(s)
- Taishi Hirai
- Department of Medicine; Section of Cardiology, University of Chicago Medical Center; Chicago Illinois
| | - Jonathan Rosenberg
- Department of Medicine; Section of Cardiology, University of Chicago Medical Center; Chicago Illinois
| | - Sandeep Nathan
- Department of Medicine; Section of Cardiology, University of Chicago Medical Center; Chicago Illinois
| | - John E. A. Blair
- Department of Medicine; Section of Cardiology, University of Chicago Medical Center; Chicago Illinois
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10
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Mechery A, Jordan PJ, Doshi SN, Khan SQ. Retrieval of a stuck Rotablator burr ("Kokeshi phenomenon") and successful percutaneous coronary intervention. J Cardiol Cases 2015; 13:90-92. [PMID: 30546615 DOI: 10.1016/j.jccase.2015.10.012] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2015] [Revised: 09/06/2015] [Accepted: 10/28/2015] [Indexed: 11/25/2022] Open
Abstract
We report the case of a 74-year-old man having angioplasty following admission with a troponin positive acute coronary syndrome. Due to heavy coronary artery calcification, rotablation was used. The procedure was complicated by a stuck burr ("Kokeshi phenomenon"). We employed a novel method to safely remove the burr and complete the procedure. <Learning objective: Various methods have been described for the retrieval of an entrapped Rotablator burr; we show in this case that deep engagement of guiding catheter and manual traction is a safe and effective method for retrieval.>.
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Affiliation(s)
- Anthony Mechery
- Department of Interventional Cardiology, University Hospitals Birmingham, Birmingham, UK
| | - Paul J Jordan
- Department of Interventional Cardiology, University Hospitals Birmingham, Birmingham, UK
| | - Sagar N Doshi
- Department of Interventional Cardiology, University Hospitals Birmingham, Birmingham, UK
| | - Sohail Q Khan
- Department of Interventional Cardiology, University Hospitals Birmingham, Birmingham, UK
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11
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Tanaka Y, Saito S. Successful retrieval of a firmly stuck rotablator burr by using a modified STAR technique. Catheter Cardiovasc Interv 2015; 87:749-56. [PMID: 26651133 DOI: 10.1002/ccd.26342] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/15/2015] [Revised: 08/15/2015] [Accepted: 11/08/2015] [Indexed: 11/08/2022]
Abstract
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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Affiliation(s)
- Yutaka Tanaka
- Department of Cardiology and Catheterization Laboratory, Shonan Kamakura General Hospital, Kamakura, Japan
| | - Shigeru Saito
- Department of Cardiology and Catheterization Laboratory, Shonan Kamakura General Hospital, Kamakura, Japan
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DAHDOUH ZIAD, ABDEL-MASSIH TONY, ROULE VINCENT, SARKIS ANTOINE, GROLLIER GILLES. Rotational Atherectomy as Endovascular Haute Couture: A Road Map of Tools and Techniques for the Interventional Management of Burr Entrapment. J Interv Cardiol 2013; 26:586-95. [DOI: 10.1111/joic.12075] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022] Open
Affiliation(s)
- ZIAD DAHDOUH
- Department of Interventional Cardiology; University Hospital of Caen; Caen France
| | - TONY ABDEL-MASSIH
- Department of Cardiology; Hotel-Dieu de France Hospital; Achrafieh Beirut Lebanon
| | - VINCENT ROULE
- Department of Interventional Cardiology; University Hospital of Caen; Caen France
| | - ANTOINE SARKIS
- Department of Cardiology; Hotel-Dieu de France Hospital; Achrafieh Beirut Lebanon
| | - GILLES GROLLIER
- Department of Interventional Cardiology; University Hospital of Caen; Caen France
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Lin CP, Wang JH, Lee WL, Ku PM, Yin WH, Tsao TP, Chang CJ. Mechanism and management of burr entrapment: A nightmare of interventional cardiologists. JOURNAL OF GERIATRIC CARDIOLOGY : JGC 2013; 10:230-4. [PMID: 24133509 PMCID: PMC3796695 DOI: 10.3969/j.issn.1671-5411.2013.03.013] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/25/2013] [Revised: 06/10/2013] [Accepted: 06/20/2013] [Indexed: 11/18/2022]
Abstract
Entrapment of the burr within calcified lesion is an uncommon, but serious complication during rotational atherectomy and usually needs surgical retrieval. We report a case series of this complication and also review the possible mechanisms, such as kokesi phenomenon or insufficient pecking motion with decreased rotational speed. We also review the potential techniques ever proposed to rescue this complication percutaneously, including simple manual traction, balloon dilation to release the trap, snaring the burr as distal as possible for forceful local traction and wedging the burr with a child catheter to facilitate retrieval. Gentle pecking motion of the burr for sufficient ablation and shortening the run less than 15 s may avoid such complications. Interventional cardiologists using the rotablator should be familiar with the tips and tricks to avoid and rescue this complication.
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Affiliation(s)
- Chia-Pin Lin
- The First Cardiovascular Division, Department of Internal Medicine, Chang Gung Memorial Hospital, Chang Gung University, College of Medicine, No. 199, Tung-Hwa North Road, Taipei, Taiwan, China
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Sulimov DS, Abdel-Wahab M, Toelg R, Kassner G, Geist V, Richardt G. Stuck rotablator: the nightmare of rotational atherectomy. EUROINTERVENTION 2013; 9:251-8. [DOI: 10.4244/eijv9i2a41] [Citation(s) in RCA: 48] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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Cheema JK, Shroff AR, Vidovich MI. Unintentional extraction of an endothelialized bare metal stent. CARDIOVASCULAR REVASCULARIZATION MEDICINE 2013; 14:187-90. [DOI: 10.1016/j.carrev.2012.12.009] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2012] [Revised: 12/13/2012] [Accepted: 12/17/2012] [Indexed: 10/27/2022]
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De Vroey F, Velavan P, El Jack S, Webster M. How should I treat an entrapped rotational atherectomy burr? EUROINTERVENTION 2012; 7:1238-44. [DOI: 10.4244/eijv7i10a197] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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17
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Muller O, Lerman A, Eeckhout E. Complications with a happy ending. EUROINTERVENTION 2011; 7:897-9. [PMID: 22157472 DOI: 10.4244/eijv7i8a141] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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Cunnington M, Egred M. GuideLiner, a child-in-a-mother catheter for successful retrieval of an entrapped rotablator burr. Catheter Cardiovasc Interv 2011; 79:271-3. [PMID: 21793173 DOI: 10.1002/ccd.23032] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/24/2011] [Accepted: 01/29/2011] [Indexed: 11/11/2022]
Abstract
Entrapment of the rotablator burr within heavily calcified lesions is a recognized complication, which usually necessitates sternotomy and open surgical intervention to retrieve the trapped burr. In some cases, the trapped burr can be retrieved using simple traction, but this is potentially hazardous with possible trauma and perforation of the vessel. Passing a wire alongside the trapped burr with ballooning to free the burr can be attempted. We describe a novel technique to remove a trapped rotablator burr from a heavily calcified lesion using counter-traction with a GuideLiner, child-in-a-mother catheter, which successfully removed the entrapped burr without the need for surgery when simple traction alone had been ineffective.
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Sakakura K, Ako J, Momomura SI. Successful removal of an entrapped rotablation burr by extracting drive shaft sheath followed by balloon dilatation. Catheter Cardiovasc Interv 2011; 78:567-70. [PMID: 21780279 DOI: 10.1002/ccd.22957] [Citation(s) in RCA: 40] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/22/2010] [Accepted: 01/02/2011] [Indexed: 11/09/2022]
Abstract
Burr entrapment is a rare but serious complication during rotational atherectomy (RA). Although emergent surgical removal is a reliable option for this complication, surgical removal is invasive and takes several hours. Balloon inflation just proximal to the burr was the previously-reported nonsurgical option for burr removal. However, this method needed large guide catheter lumen (≥8 Fr). We present a case of 67-year-old male on chronic hemodialysis. During RA for severe stenosis of the right coronary artery, the RA burr was entrapped. We cut off the drive shaft, the drive shaft sheath, and the RA wire together near the advancer, and then we removed the drive shaft sheath. After removing the drive shaft sheath, the 2.5 mm balloon easily entered the 7-Fr guide catheter. We inflated that balloon to a pressure of 18 atm. The burr was easily removed immediately after balloon deflation. Removal of the drive shaft sheath following balloon dilatation is a new, nonsurgical bailout method for a burr that becomes entrapped during RA. Since removal of the drive shaft sheath following balloon dilatation can be applied to 7 Fr as well as 6 Fr guide systems, this method may be of considerable benefit when operators use 7 Fr or 6 Fr systems.
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Affiliation(s)
- Kenichi Sakakura
- Division of Cardiovascular Medicine, Department of Integrated Medicine I, Jichi Medical University Saitama Medical Center, Amanuma 1-847, Omiya, Saitama, Japan.
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Kimura M, Shiraishi J, Kohno Y. Successful retrieval of an entrapped Rotablator burr using 5 Fr guiding catheter. Catheter Cardiovasc Interv 2011; 78:558-64. [PMID: 21547995 DOI: 10.1002/ccd.22995] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/16/2011] [Accepted: 01/17/2011] [Indexed: 11/07/2022]
Abstract
BACKGROUND Although burr entrapment is a rare complication of the Rotablator, it is extremely difficult to retrieve a fixedly entrapped burr without surgical procedure. CASE REPORT An 84-year-old male with effort angina had heavily calcified coronary trees as well as severe stenosis in the mid LCx, and moderate stenosis in the proximal LCx, and in the LMT. We planned to perform rotational atherectomy in the LCx lesions. Using 7 Fr Q-curve guiding catheter and Rotawire floppy, we began to ablate using 1.5-mm burr at 200,000 rpm. Because the burr could not pass the proximal stenosis, we exchanged the wire for Rotawire extrasupport and the burr for 1.25-mm burr, and restarted the ablation at 220,000 rpm. Although the burr could manage to pass the proximal stenosis, it had become trapped in the mid LCx lesion. Simple pull on the Rotablator, rotation of the burr, and crossing the Conquest (Confianza) wire could not retrieve it. Thus, we cut off the drive shaft and sheath of the Rotablator, inserted 5 Fr 120-cm straight guiding catheter (Heartrail ST01; Terumo) through the remaining Rotablator system, pushed the catheter tip to the lesion around the burr as well as simultaneously pulled the Rotablator, and finally could retrieve it. Then we implanted stents in the LCx and in the LMT without difficulty. CONCLUSIONS The 5 Fr straight guiding catheter might be useful for retrieving an entrapped burr (1.25-mm burr).
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Affiliation(s)
- Masayoshi Kimura
- Department of Cardiology, Japanese Red Cross Kyoto Daiichi Hospital, Honmachi, Higashiyama-ku, Kyoto, Japan.
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HO PAULC, WEATHERBY TINAM, DUNLAP MARILYN. Burr Erosion in Rotational Ablation of Metallic Coronary Stent: An Electron Microscopic Study. J Interv Cardiol 2010; 23:233-9. [DOI: 10.1111/j.1540-8183.2010.00543.x] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
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Saito S. Penetrating might be easier than retrieving. Catheter Cardiovasc Interv 2004; 63:473. [PMID: 15558777 DOI: 10.1002/ccd.20129] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
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