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Rotablator: stuck burr or blocked rota and shaft fractures

Coronary embolised device complications

Rotational Atherectomy (RA), a proven and valuable procedure, is a dedicated technique for calcified lesions. Complications related to the Rotablator system have become relatively rare, but they are seen to occur.

This section raises awareness of what complications exist in using the Rotablator system and how to best manage them if they occur. We look at several complications including when a burr gets stuck within or beyond the stenosis, when a shaft fractures or when the rota is blocked. Learn valuable tips & tricks in this section.

PCR Complications Team: Patrick Calvert, Eric Eeckhout, Michael Haude and Olivier Muller

Medical assistant: Julien Adjedj, Stephane Fournier

The 3 main scenarios that can be encountered are:

  • Stuck burr (in or beyond the stenosis) - Kokeshi phenomenon
  • Shaft fracture
  • Wire under stent struts and rota blocked

STUCK BURR
(IN OR BEYOND STENOSIS)

Burr entrapment is a rare and challenging complication of rotablation. Learn what techniques might be used and follow the step-by-step approach to dealing with this complication.

STUCK BURR

complications rota stuck burr: illustration

ROTABLATOR BURR /
SHAFT DISCONNECTION

In the case of rota burr or shaft disconnection, the burr has become stuck and when an attempt is made to take it out, the broken shaft could be either within or outside the guiding catheter. Discover how to manage this complication here!

ROTA BURR

complications rota shaft disconnection: illustration

WIRE UNDER STENT STRUTS 
& ROTA BLOCKED

Complications using the Rotablator system are increasingly rare, but what if one occurred - for instance, a wire under the stent struts with a blocked rota? Learn how to deal with this complication here.

WIRE UNDER STRUTS

complications rota wire under struts: illustration

Each type of complication is presented in three parts, namely:

  • Part 1 - Introduction
  • Part 2 - Management algorithm/decision tree and additional links
  • Part 3 - Case library

Key messages

  • Be aware of proper position of the rota wire, especially when passing or addressing implanted stents
  • Prevent burst stalling by keeping the speed
  • Verify the connection of the rota advancer and rota catheter

References

Please consult the additional references linked to Rota complication.

In addition to this complication management resource, further cases on complications are available on the website in the Topics section or consult the other complications or calcified lesions sections on the website.